Ringel Reingard, Maas Renke
Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Gerodontology. 2016 Dec;33(4):447-452. doi: 10.1111/ger.12181. Epub 2015 Feb 9.
To investigate how German dentists adhere to recommendations regarding dental treatment of patients taking antiplatelet or oral anticoagulation therapy for cardiovascular protection.
Discontinuation of antiplatelet or oral anticoagulation therapy prior to dental procedures is usually not recommended because the risk of thromboembolic events is higher than that of significant procedure-related bleeding.
An anonymous questionnaire regarding the handling of and experiences with patients taking aspirin (acetylsalicylic acid) or vitamin-K-antagonists (phenprocoumon) was distributed to approximately 4500 dentists attending the national German Dentists Day 2011.
Of 146 dentists who completed the questionnaire 77.4% and 27.6% stated that they perform tooth extractions under continued therapy with aspirin or vitamin-K-antagonists, respectively. When asked regarding the INR or Quick values, they require for tooth extractions in patients taking oral anticoagulants 29.5% of the dentists provided values that were outside the safe range (INR ≤1.5 or ≥3.5) and 90.7% accepted values too old to be clinically reliable. For pain relief after dental procedures, 71.2% of the dentists recommended ibuprofen notwithstanding the fact that it attenuates protective effects of aspirin and 10.2% would discontinue aspirin and prescribe ibuprofen or paracetamol (acetaminophen).
Despite similar recommendations the majority of dentists perform tooth extractions in patients taking aspirin but not in patients taking vitamin-K-antagonists. Moreover, a potentially unfavourable drug interaction of aspirin and ibuprofen is frequently not considered. In patients taking vitamin-K-antagonists too many dentists rely on laboratory values that are too old or outside the recommended range.
调查德国牙医如何遵循关于为心血管保护而接受抗血小板或口服抗凝治疗的患者进行牙科治疗的建议。
通常不建议在牙科手术前停用抗血小板或口服抗凝治疗，因为血栓栓塞事件的风险高于与手术相关的严重出血风险。
向参加2011年德国全国牙医日的约4500名牙医发放了一份关于处理服用阿司匹林（乙酰水杨酸）或维生素K拮抗剂（苯丙香豆素）的患者的情况及经验的匿名调查问卷。
在146名完成问卷的牙医中，分别有77.4%和27.6%表示他们在患者继续服用阿司匹林或维生素K拮抗剂的情况下进行拔牙。当被问及口服抗凝剂患者拔牙所需的国际标准化比值（INR）或Quick值时，29.5%的牙医提供的值超出了安全范围（INR≤1.5或≥3.5），90.7%接受的数值因时间太久而在临床上不可靠。对于牙科手术后的疼痛缓解，71.2%的牙医推荐使用布洛芬，尽管它会减弱阿司匹林的保护作用，10.2%的牙医会停用阿司匹林并开布洛芬或对乙酰氨基酚（扑热息痛）。
尽管有类似的建议，但大多数牙医对服用阿司匹林的患者进行拔牙，而对服用维生素K拮抗剂的患者则不进行。此外，阿司匹林和布洛芬之间潜在的不良药物相互作用常常未被考虑。对于服用维生素K拮抗剂的患者，太多牙医依赖过时或超出推荐范围的实验室值。
