Girotra C, Padhye M, Mandlik G, Dabir A, Gite M, Dhonnar R, Pandhi V, Vandekar M
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyanagar, Nerul, Navi Mumbai, India.
Int J Oral Maxillofac Surg. 2014 Jan;43(1):99-106. doi: 10.1016/j.ijom.2013.08.014. Epub 2013 Sep 25.
Controversy exists concerning the suspension or maintenance of anti-platelet drugs before elective surgical procedures. We assessed the association of the risk of prolonged postoperative bleeding with anti-platelet therapy by type of minor surgical procedure and the association between anti-platelet therapy and the level of hemostatic measures required. Five hundred and forty-six patients were included in the study group: those on aspirin (n = 310), clopidogrel (n = 97), and aspirin + clopidogrel dual therapy (n = 139); the control group comprised 575 healthy individuals. Cramer's V test was significant (P < 0.05) but showed a weak association between anti-platelet therapy and prolonged immediate postoperative bleeding. Compared to controls, the odds ratio revealed that the risk of prolonged bleeding in the immediate postoperative period was significantly higher with dual therapy, followed by clopidogrel and aspirin. Prolonged bleeding occurred in 22 patients in the study group and 20 in the control group, and was successfully controlled with local hemostatic measures. Fisher's exact test showed a significant association between dual therapy and higher levels of hemostatic measures (P = 0.004; P = 0.035). Prolonged bleeding in patients on anti-platelet therapy was independent of the type of minor surgical procedure. The greatest risk of prolonged bleeding was found in patients on dual therapy; this required higher levels of hemostatic measures.
关于在择期外科手术前停用或继续使用抗血小板药物存在争议。我们根据小型外科手术类型评估了抗血小板治疗与术后出血时间延长风险之间的关联，以及抗血小板治疗与所需止血措施水平之间的关联。研究组纳入了546例患者：服用阿司匹林的患者（n = 310）、服用氯吡格雷的患者（n = 97）以及服用阿司匹林+氯吡格雷双联治疗的患者（n = 139）；对照组包括575名健康个体。克莱默V检验具有显著性（P < 0.05），但显示抗血小板治疗与术后即刻出血时间延长之间的关联较弱。与对照组相比，比值比显示双联治疗术后即刻出血时间延长的风险显著更高，其次是氯吡格雷和阿司匹林。研究组有22例患者出现出血时间延长，对照组有20例，通过局部止血措施成功控制。费舍尔精确检验显示双联治疗与更高水平的止血措施之间存在显著关联（P = 0.004；P = 0.035）。接受抗血小板治疗患者的出血时间延长与小型外科手术类型无关。双联治疗患者出血时间延长的风险最大；这需要更高水平的止血措施。
