Dewan Karun, Vithlani Viren, Patel Neil, Warren Kathy
School of Dentistry, Birmingham Dental Hospital, St Chad's Queensway, Birmingham, UK.
Dent Update. 2012 Oct;39(8):578-80, 583-4, 586-7. doi: 10.12968/denu.2012.39.8.578.
Current management protocols for anticoagulated patients undergoing dental procedures are influenced by evidence-based guidelines. These guidelines state that the risk of significant bleeding is low in patients who have a stable INR within a therapeutic range, (2-4). The risks of interruption of anticoagulant therapy is greater than the risk of bleeding. This paper discusses the current practice of general dental practitioners (GDPs) in the West Midlands when treating patients taking warfarin and compares these findings with standard guidelines. A questionnaire was sent to 638 GDPs in West Midlands in 2010, 492 (77%) were returned. This study was carried out three years after a similar study carried out in South West Wales and after the guidance updated by the BNF and NMWIC. Thirty-three (7%) of the respondents did not treat patients on warfarin. The majority of respondents (86%) considered that a dental extraction in a patient on warfarin is a procedure associated with a high risk of bleeding. Surgical implant placement (75%), subgingival debridement (49%) and inferior dental block (40%) administration were also considered by GDPs to be associated with a high risk of bleeding.The majority (88%) of the respondents check the INR of anticoagulated patients before carrying out treatment. Of these, 244 (52%) would do so within 24 hours and 78 (17%) of them within 72 hours. Only 117 (25%) considered 4.0 as the safe upper limit for the INR for performing high-risk procedures.
The findings of this study demonstrate that there is general awareness about how to manage patients on warfarin but uncertainties still exist among general dental practitioners. Further education and training would improve the care of patients on warfarin in a primary care setting.
目前，接受牙科手术的抗凝患者的管理方案受到循证指南的影响。这些指南指出，国际标准化比值（INR）在治疗范围内保持稳定（2 - 4）的患者发生严重出血的风险较低。中断抗凝治疗的风险大于出血风险。本文讨论了西米德兰兹郡普通牙科医生（GDPs）在治疗服用华法林患者时的当前做法，并将这些结果与标准指南进行比较。2010年向西米德兰兹郡的638名普通牙科医生发送了问卷，492份（77%）被收回。这项研究是在威尔士西南部进行的类似研究三年后，以及英国国家处方集（BNF）和国家医疗保健改善与创新研究所（NMWIC）更新指南之后进行的。33名（7%）受访者不治疗服用华法林的患者。大多数受访者（86%）认为，服用华法林的患者进行拔牙是一项出血风险高的手术。普通牙科医生还认为，植入手术（75%）、龈下刮治（49%）和下牙槽神经阻滞（40%）注射也与高出血风险相关。大多数（88%）受访者在进行治疗前会检查抗凝患者的INR。其中，244名（52%）会在24小时内检查，78名（17%）会在72小时内检查。只有117名（25%）认为INR为4.0是进行高风险手术的安全上限。
本研究结果表明，对于如何管理服用华法林的患者普遍有认识，但普通牙科医生中仍存在不确定性。进一步的教育和培训将改善基层医疗环境中服用华法林患者的护理。
