Sui J, Devoize L, Gonnu-Levallois S, Mulliez A, Baudet-Pommel M, Barthélémy I, Dang N Pham
NHE, service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
NHE, service d'odontologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; UMR Inserm/UdA, U1107, neuro-dol, trigeminal pain and migraine, faculté de chirurgie dentaire, BP 10448, 63000 Clermont-Ferrand, France; Faculté de chirurgie dentaire, Clermont université, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France.
Rev Stomatol Chir Maxillofac Chir Orale. 2015 Feb;116(1):5-11. doi: 10.1016/j.revsto.2014.10.004. Epub 2014 Nov 20.
Tooth extraction for patients treated by AVK and/or platelet aggregation inhibitor is performed according to local habits rather than to a consensus. We had for objective to assess hemorrhagic and thromboembolic risks for patients for whom treatment with AVK and/or platelet aggregation inhibitor was modified before tooth extraction.
Ninety-three patient files were examined retrospectively. The following data was collected: epidemiological data, ASA score, nature and changes of antithrombotic therapy, preoperative INR, number teeth extracted, postoperative complications (bleeding and thromboembolic events).
Thirty-seven patients were treated with oral anticoagulants, 41 by a platelet aggregation inhibitor, 10 by double platelet aggregation inhibitor therapy, and 5 by an AVK-platelet aggregation inhibitor combination. At D0, the mean INR was decreased to 1.4, 4 patients with high thromboembolic risk had received heparin relay treatment; the treatment was stopped for 9 of the 56 patients on monotherapy with antiplatelet therapy, 4 were switched from clopidogrel to lysine acetylate; clopidogrel was stopped for 7 patients under combination therapy. Seven hundred and twenty-six avulsions (mean 8.1 per patient) were performed, 41 patients presented with mild/moderate bleeding, easily resolved. A patient presented with delayed hemorrhage at D6 (AVK overdose). No thromboembolic complication was reported.
The modification of antithrombotic treatment, as for surgery at high risk of bleeding, seems to limit the risk of bleeding without increasing thromboembolic risk.
对于接受维生素K拮抗剂（AVK）和/或血小板聚集抑制剂治疗的患者，拔牙操作是根据当地习惯而非达成的共识进行的。我们的目标是评估在拔牙前调整AVK和/或血小板聚集抑制剂治疗的患者的出血和血栓栓塞风险。
回顾性检查了93份患者病历。收集了以下数据：流行病学数据、美国麻醉医师协会（ASA）评分、抗血栓治疗的性质和变化、术前国际标准化比值（INR）、拔牙数量、术后并发症（出血和血栓栓塞事件）。
37例患者接受口服抗凝剂治疗，41例接受血小板聚集抑制剂治疗，10例接受双重血小板聚集抑制剂治疗，5例接受AVK - 血小板聚集抑制剂联合治疗。在D0时，平均INR降至1.4，4例高血栓栓塞风险患者接受了肝素替代治疗；56例接受抗血小板单药治疗的患者中有9例停止治疗，4例从氯吡格雷改为赖氨酸乙酰化药物；联合治疗的7例患者停用了氯吡格雷。共进行了726颗牙拔除（平均每位患者8.1颗），41例患者出现轻度/中度出血，易于解决。1例患者在D6出现延迟性出血（AVK过量）。未报告血栓栓塞并发症。
对于出血风险高的手术，抗血栓治疗的调整似乎在不增加血栓栓塞风险的情况下降低了出血风险。
