Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea.
Clin Cardiol. 2012 Apr;35(4):225-30. doi: 10.1002/clc.21960. Epub 2012 Jan 25.
The risk of excessive bleeding prompts physicians to stop multiple antiplatelet agents before minor surgery, which puts coronary stenting patients at risk for adverse thrombotic events.
We hypothesized that most dental extractions can be carried out safely without stopping multiple antiplatelet agents.
All dental extraction patients who had undergone coronary stenting and who were also on oral multiple antiplatelet agents therapy were enrolled. One hundred patients underwent dental procedures without stopping antiplatelet agents. All wounds were sutured and followed up at 24 hours, 1 week, and 1 month after the procedure. There were 2233 patients who had not taken oral antiplatelet agents from a health promotion center and had teeth extracted by the same method. After performing propensity-score matching for the entire population, a total of 100 matched pairs of patients were created. The primary outcome was a composite of excessive intraextraction blood loss, transfusion, and rehospitalization for bleeding, and the secondary outcome was a composite of death, nonfatal myocardial infarction, target lesion revascularization, and stent thrombosis within 1 month after the procedure.
There were 2 excessive intraextraction bleeding cases that continued at the extraction site for 4 and 5 hours, respectively, in the coronary stenting patients, and 1 excessive intraextraction bleeding case that continued for 3 hours in the control patients. There were no cases of transfusion, rehospitalization for bleeding, or major cardiovascular events for the 2 propensity-matched groups.
We found that most dental extractions in coronary stenting patients can be carried out safely without stopping multiple antiplatelet agents.
出血风险促使医生在进行小型手术前停止使用多种抗血小板药物，这使得接受冠状动脉支架置入术的患者面临不良血栓事件的风险。
我们假设大多数拔牙操作可以在不停用多种抗血小板药物的情况下安全进行。
所有接受过冠状动脉支架置入术且正在接受口服多种抗血小板药物治疗的拔牙患者均被纳入研究。100 例患者在不停用抗血小板药物的情况下接受了拔牙手术。所有伤口均进行缝合，并在术后 24 小时、1 周和 1 个月进行随访。从健康促进中心招募了 2233 例未服用口服抗血小板药物且采用相同方法拔牙的患者。对全人群进行倾向评分匹配后，共创建了 100 对匹配的患者。主要结局是评估术中及术后过度出血、输血和因出血再次住院的复合事件，次要结局是评估术后 1 个月内死亡、非致死性心肌梗死、靶病变血运重建和支架血栓形成的复合事件。
在冠状动脉支架置入术患者中，有 2 例术中出现持续 4 小时和 5 小时的拔牙部位过度出血，对照组中有 1 例术中出现持续 3 小时的过度出血。两组患者均未发生输血、因出血再次住院或主要心血管事件。
我们发现，大多数接受冠状动脉支架置入术的患者可以在不停用多种抗血小板药物的情况下安全地进行拔牙操作。
