Department of Dentoalveolar Surgery, Implant Surgery and Radiology, Aristotle University Dental School, Thessaloniki, Greece.
Am J Cardiol. 2011 Oct 1;108(7):964-7. doi: 10.1016/j.amjcard.2011.05.029. Epub 2011 Jul 23.
Optimal dental management in patients on long-term antiplatelet treatment is not clearly defined. Antiplatelet discontinuation increases the risk of thrombotic complications, whereas uninterrupted antiplatelet therapy, which is the currently recommended approach, is assumed to increase the bleeding hazard after dental procedures. We sought to prospectively compare the risk of immediate and late postextraction bleeding in patients receiving uninterrupted single or dual antiplatelet therapy. We recruited 643 consecutive patients referred for dental extractions. In total 111 (17.3%) were on clinically indicated antiplatelet therapy: aspirin (n = 42), clopidogrel (n = 36), and aspirin and clopidogrel (n = 33). Controls (n = 532, 82.7%) were not on antiplatelet treatment. Immediate and late bleeding complications were recorded. Compared to controls the risk of prolonged immediate bleeding was higher in patients on dual antiplatelet therapy (relative risk [RR] 177.3, 95% confidence interval [CI] 43.5 to 722, p <0.001) but not in patients on aspirin alone (RR = 6.3, 95% CI 0.6 to 68.4, p = 0.2) or clopidogrel alone (RR = 7.4, 95% CI 0.7 to 79.5, p = 0.18); however, all immediate bleeding complications in all treatment groups were successfully managed with local hemostatic measures. No patient developed any late hemorrhage. In conclusion, dental extractions may be safely performed in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken, thus averting thrombotic risk of temporary antiplatelet discontinuation.
长期接受抗血小板治疗的患者的最佳牙科管理尚不清楚。停用抗血小板药物会增加血栓并发症的风险，而不停用抗血小板药物（目前推荐的方法）被认为会增加牙科手术后出血的风险。我们旨在前瞻性比较接受不间断单一或双重抗血小板治疗的患者即刻和延迟拔牙后出血的风险。我们招募了 643 名连续接受拔牙的患者。共有 111 名（17.3%）患者接受了临床推荐的抗血小板治疗：阿司匹林（n = 42）、氯吡格雷（n = 36）和阿司匹林加氯吡格雷（n = 33）。对照组（n = 532，82.7%）未接受抗血小板治疗。记录即刻和延迟出血并发症。与对照组相比，接受双重抗血小板治疗的患者即刻延长出血的风险更高（相对风险 [RR] 177.3，95%置信区间 [CI] 43.5 至 722，p <0.001），但单独使用阿司匹林的患者（RR = 6.3，95% CI 0.6 至 68.4，p = 0.2）或氯吡格雷单独使用的患者（RR = 7.4，95% CI 0.7 至 79.5，p = 0.18）则不然；然而，所有治疗组的所有即刻出血并发症均通过局部止血措施成功处理。没有患者发生任何迟发性出血。总之，在采取适当的局部止血措施的情况下，接受单一或双重抗血小板治疗的患者可以安全地进行拔牙，从而避免暂时停用抗血小板药物引起的血栓风险。
