Ohba Seigo, Yoshimura Hitoshi, Matsuda Shinpei, Kobayashi Junichi, Kimura Takashi, Aiki Minako, Nagase Jun, Ishimaru Kyoko, Sano Kazuo
Division of Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan,
Odontology. 2015 May;103(2):227-32. doi: 10.1007/s10266-014-0150-9. Epub 2014 Mar 11.
It has been proposed that minor oral surgery can be performed safely in patients taking antithrombotic therapy without interrupting treatment; however, there is little evidence-based guidance about how to manage postoperative hemorrhage in patients taking antithrombotics, and few randomized trials that help to inform the risk-benefit ratio of continuing or suspending antithrombotic therapy. The aim of this study was to identify risk factors for postoperative hemorrhage to create a protocol for patients undergoing minor oral surgery with antithrombotic therapy. One hundred and two patients were enrolled, who subsequently underwent 142 minor oral surgical procedures while taking antithrombotic therapy. Demographic details including age and sex, laboratory coagulation investigations, and episodes of postoperative hemorrhage were recorded. The prothrombin time-international normalized ratio (PT-INR) of participants taking warfarin was <3.0 in all cases (mean 1.89 ± standard deviation 0.52; range 1.11-2.82). The activated partial thromboplastin time (APTT) was significantly associated with postoperative hemorrhage, which was significantly increased in patients taking warfarin alone or in combination with an antiplatelet agent compared with an antiplatelet agent alone. In 7 cases, postoperative hemorrhage continued for 4 days and more, requiring additional local hemostatic management. Our findings suggest that minor oral surgery can be performed under antithrombotic therapy without the need of discontinuing the antithrombotic agents. Local hemostatic materials did not suppress postoperative hemorrhage. APTT is a possible prediction factor for postoperative hemorrhage in such patients and, therefore, should be determined prior to minor oral surgery in addition to PT-INR value.
有人提出，接受抗血栓治疗的患者可以安全地进行小型口腔手术，而无需中断治疗；然而，关于如何处理接受抗血栓治疗患者的术后出血，几乎没有基于证据的指导意见，而且很少有随机试验有助于了解继续或暂停抗血栓治疗的风险效益比。本研究的目的是确定术后出血的危险因素，为接受小型口腔手术并进行抗血栓治疗的患者制定方案。共纳入102例患者，这些患者在接受抗血栓治疗期间随后接受了142例小型口腔外科手术。记录了包括年龄和性别在内的人口统计学细节、实验室凝血检查结果以及术后出血情况。所有服用华法林的参与者的凝血酶原时间-国际标准化比值（PT-INR）均<3.0（平均值1.89±标准差0.52；范围1.11-2.82）。活化部分凝血活酶时间（APTT）与术后出血显著相关，与单独使用抗血小板药物相比，单独使用华法林或与抗血小板药物联合使用的患者术后出血显著增加。在7例患者中，术后出血持续4天及以上，需要额外的局部止血处理。我们的研究结果表明，在抗血栓治疗下可以进行小型口腔手术，无需停用抗血栓药物。局部止血材料并不能抑制术后出血。APTT是此类患者术后出血的一个可能预测因素，因此，除了PT-INR值外，在小型口腔手术前还应测定APTT。
