Bajkin Branislav V, Urosevic Ivana M, Stankov Karmen M, Petrovic Bojan B, Bajkin Ivana A
Dental Clinic of Vojvodina, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 12, 21000 Novi Sad, Serbia.
Clinical Center of Vojvodina, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 1, 21000 Novi Sad, Serbia.
Br J Oral Maxillofac Surg. 2015 Jan;53(1):39-43. doi: 10.1016/j.bjoms.2014.09.009. Epub 2014 Oct 11.
Our aim was to evaluate the effects of single and dual antiplatelet treatment on postoperative bleeding in patients having dental extractions. The prospective clinical study included 160 patients who were taking antiplatelet drugs. The first group (n=43) were taking 2 drugs, mostly aspirin and clopidogrel, and the second group (n=117) were taking a single antiplatelet drug in the form of aspirin (n=84), clopidogrel (n=20), and ticlopidine (n=13). All patients had simple dental extractions, and local haemostasis was with resorbable collagen sponges, without suturing of the wound. The control group comprised 105 healthy subjects with a similar number of dental extractions. Bleeding was an "event" if it continued for more than 12h, made the patient call or return to the dental practice or emergency department, induced a large haematoma or ecchymosis within the oral soft tissues, or required blood transfusion. A total of 110 teeth were extracted on 59 occasions in the dual drug group, and 232 teeth on 128 occasions in the single drug group. Bleeding was recorded after extraction in only one patient on dual aspirin-clopidogrel treatment, which was mild and easily controlled by local haemostasis. The incidence of postoperative bleeding did not differ significantly among the three groups (χ(2)=4.3, p=0.11). However, the wound was sutured to achieve effective initial local haemostasis in 4/59 (6.8%) and 2/128 (1.6%) occasions of tooth extractions in the dual and single drug groups, respectively, and none in the control group (χ(2)=10.02, p=0.007). Patients taking single or dual antiplatelet drugs may have teeth extracted safely without interruption of treatment using only local haemostatic measures.
我们的目的是评估单药和双药抗血小板治疗对拔牙患者术后出血的影响。这项前瞻性临床研究纳入了160名正在服用抗血小板药物的患者。第一组（n = 43）服用两种药物，主要是阿司匹林和氯吡格雷，第二组（n = 117）服用单一抗血小板药物，包括阿司匹林（n = 84）、氯吡格雷（n = 20）和噻氯匹定（n = 13）。所有患者均接受简单拔牙，局部止血采用可吸收胶原海绵，伤口不缝合。对照组包括105名进行了相似数量拔牙的健康受试者。如果出血持续超过12小时、导致患者致电或返回牙科诊所或急诊科、在口腔软组织内形成大血肿或瘀斑，或需要输血，则将其视为一次“事件”。双药组在59次拔牙中总共拔除了110颗牙齿，单药组在128次拔牙中总共拔除了232颗牙齿。接受阿司匹林-氯吡格雷联合治疗的患者中仅有1例拔牙后出现出血，出血症状较轻，通过局部止血易于控制。三组术后出血发生率差异无统计学意义（χ(2)=4.3，p = 0.11）。然而，双药组和单药组分别有4/59（6.8%）和2/128（1.6%）的拔牙病例需要缝合伤口以实现有效的初始局部止血，对照组无一例需要缝合（χ(2)=10.02，p = 0.007）。服用单药或双药抗血小板药物的患者可以安全拔牙，无需中断治疗，仅采用局部止血措施即可。
