Wahl Michael J, Pinto Andres, Kilham Jessica, Lalla Rajesh V
Christiana Care Health System, Wilmington, Delaware, USA.
University Hospitals Case Medical Center and Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Feb;119(2):136-57. doi: 10.1016/j.oooo.2014.10.011. Epub 2014 Nov 13.
In a literature review, the incidence and morbidity of bleeding complications after dental surgery in anticoagulated patients was compared with embolic complications when anticoagulation was interrupted. Over 99% of anticoagulated patients had no postoperative bleeding that required more than local hemostatic measures. Of more than 5431 patients undergoing more than 11,381 surgical procedures, with many patients at higher than present therapeutic intenational normalized ratio (INR) levels, only 31 (∼0.6% of patients) required more than local hemostasis to control the hemorrhage; none died due to hemorrhage. Among at least 2673 patients whose warfarin dose was reduced or withdrawn for at least 2775 visits for dental procedures, there were 22 embolic complications (0.8% of cessations), including 6 fatal events (0.2% of cessations). The embolic morbidity risk in patients whose anticoagulation is interrupted for dental surgery exceeds that of significant bleeding complications in patients whose anticoagulation is continued, even when surgery is extensive. Warfarin anticoagulation, therefore, should not be interrupted for most dental surgery.
在一项文献综述中，对比了抗凝患者牙科手术后出血并发症的发生率和发病率与抗凝中断时的栓塞并发症情况。超过99%的抗凝患者术后出血无需采取除局部止血措施之外的更多措施。在接受超过11381例外科手术的5431多名患者中，许多患者的国际标准化比值（INR）高于当前治疗水平，只有31例（约占患者的0.6%）需要采取除局部止血之外的措施来控制出血；无患者因出血死亡。在至少2673例因牙科手术而减少或停用华法林剂量至少2775次的患者中，有22例栓塞并发症（占停药次数的0.8%），包括6例致命事件（占停药次数的0.2%）。即使手术范围广泛，因牙科手术而中断抗凝的患者发生栓塞的风险也超过了继续抗凝患者发生严重出血并发症的风险。因此，对于大多数牙科手术，不应中断华法林抗凝治疗。
