氯吡格雷与全口拔牙后出血并发症增加无关：一项回顾性研究。

Clopidogrel is not associated with increased bleeding complications after full-mouth extraction: A retrospective study.

作者信息

Omar Hesham R, Socias Stephanie M, Powless R Andrew, Sprenker Collin, Karlnoski Rachel, Mangar Devanand, Camporesi Enrico M

出版信息

J Am Dent Assoc. 2015 May;146(5):303-9. doi: 10.1016/j.adaj.2015.01.002.

DOI:10.1016/j.adaj.2015.01.002

PMID:25925522

Abstract

BACKGROUND

To the authors' knowledge, the effect of clopidogrel on bleeding complications during full-mouth extraction has not been studied. The authors aimed to determine the safety of continued use of clopidogrel during full-mouth extraction.

METHODS

The authors performed a retrospective study of consecutive patients undergoing full-mouth extraction who were taking aspirin, clopidogrel, a combination of aspirin and clopidogrel, or neither. The main study outcomes in the 4 study groups were estimated blood loss, transfusion requirements, and complications. The authors also examined the correlation between the number of teeth extracted and estimated blood loss in various groups.

RESULTS

Seventy-one patients underwent full-mouth extraction with removal of an average of 19 teeth. The authors excluded 3 patients owing to lack of data regarding blood loss. Of the remaining 68 patients, 25 were using aspirin, 12 were using clopidogrel, 9 were using both aspirin and clopidogrel, and 22 had discontinued the use of antiplatelets. There was no significant difference in the number of teeth extracted (P = .283) and estimated blood loss (P = .111) among the 4 groups. The authors found a significant moderate correlation between the number of teeth extracted and estimated blood loss in the group using aspirin (r = 0.537; P = .006) and in the group using clopidogrel, whether alone or in combination with aspirin (r = 0.535; P = .012), but not in the group who discontinued the use of antiplatelets. There was no need for blood transfusion in any patient.

CONCLUSIONS

The results of this study provide limited evidence to suggest that continuation of clopidogrel during full-mouth extraction and preprosthetic surgery may be safe and does not appear to be associated with a significant risk of bleeding.

PRACTICAL IMPLICATIONS

Clopidogrel therapy during full-mouth extraction is not associated with significant bleeding complications and may be continued in patients who have a high risk of experiencing a cardiac event.

摘要

背景

据作者所知，尚未研究氯吡格雷对全口拔牙术中出血并发症的影响。作者旨在确定全口拔牙术中继续使用氯吡格雷的安全性。

方法

作者对连续接受全口拔牙术的患者进行了一项回顾性研究，这些患者正在服用阿司匹林、氯吡格雷、阿司匹林和氯吡格雷的组合，或均未服用。4个研究组的主要研究结局为估计失血量、输血需求和并发症。作者还检查了不同组中拔牙数量与估计失血量之间的相关性。

结果

71例患者接受了全口拔牙术，平均拔除19颗牙齿。作者排除了3例因缺乏失血量数据的患者。在其余68例患者中，25例正在使用阿司匹林，12例正在使用氯吡格雷，9例同时使用阿司匹林和氯吡格雷，22例已停用抗血小板药物。4组之间的拔牙数量（P = 0.283）和估计失血量（P = 0.111）无显著差异。作者发现，在使用阿司匹林的组中（r = 0.537；P = 0.006）以及在单独使用氯吡格雷或与阿司匹林联合使用氯吡格雷的组中（r = 0.535；P = 0.012），拔牙数量与估计失血量之间存在显著的中度相关性，但在停用抗血小板药物的组中不存在。所有患者均无需输血。