Mingarro-de-León Ana, Chaveli-López Begonya, Gavaldá-Esteve Carmen
Degree in Dental Surgery. Master in Oral Medicine and Surgery. Valencia University Medical and Dental School. Valencia, Spain.
Associate Professor of Oral Medicine. Valencia University Medical and Dental School. Valencia, Spain.
J Clin Exp Dent. 2014 Apr 1;6(2):e155-61. doi: 10.4317/jced.51215. eCollection 2014 Apr.
Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can give rise to complications associated with important morbidity-mortality. The dental treatment of patients who tend to an increased risk of bleeding due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis, and the optimized management of such patients, are therefore very important issues.
A study is made of the anticoagulant / antiplatelet drugs currently available on the market, with evaluation of the risks and benefits of suspending such drugs prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients.
A literature search was made in the PubMed, Cochrane Library and Scopus databases, covering all studies published in the last 5 years in English and Spanish. Studies conducted in humans and with scientific evidence levels 1 and 2 (metaanalyses, systematic reviews, randomized phase 1 and 2 trials, cohort studies and case-control studies) were considered. The keywords used for the search were: tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol.
Many management protocols have been developed, though in all cases a full clinical history is required, together with complementary hemostatic tests to minimize any risks derived from dental treatment. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from dental treatment. Key words:Tooth extraction, oral surgery, hemostasis, platelet aggregation inhibitors, antiplatelet drugs, anticoagulants, warfarin, acenocoumarol.
对于侵入性牙科治疗的成功而言，充分止血至关重要，因为出血问题可能引发与严重发病率-死亡率相关的并发症。在牙科专业人员的日常实践中，对因使用抗凝药和/或抗血小板药物而有出血风险增加倾向的患者进行牙科治疗提出了一项挑战。因此，充分了解止血的潜在机制以及对此类患者进行优化管理是非常重要的问题。
对目前市场上可用的抗凝/抗血小板药物进行研究，评估在侵入性牙科治疗前停用此类药物的风险和益处。此外，对这些患者目前使用的管理方案进行综述。
在PubMed、Cochrane图书馆和Scopus数据库中进行文献检索，涵盖过去5年以英文和西班牙文发表的所有研究。考虑在人类中进行的、具有1级和2级科学证据水平（荟萃分析、系统评价、随机1期和2期试验、队列研究和病例对照研究）的研究。检索所用的关键词为：拔牙、口腔外科手术、止血、血小板聚集抑制剂、抗血小板药物、抗凝剂、华法林、醋硝香豆素。
已经制定了许多管理方案，不过在所有情况下都需要完整的临床病史以及辅助止血测试，以尽量减少牙科治疗带来的任何风险。许多作者认为，除非开处方的医生指示，否则不应改变或停用用于治疗基础疾病的患者药物。局部止血措施已被证明足以控制牙科治疗可能导致的出血问题。关键词：拔牙、口腔外科手术、止血、血小板聚集抑制剂、抗血小板药物、抗凝剂、华法林、醋硝香豆素。
