Weltman Naamah Jacobs, Al-Attar Yasmeen, Cheung Johnson, Duncan David Philip Bruce, Katchky Ashley, Azarpazhooh Amir, Abrahamyan Lusine
University of Toronto, Toronto, ON.
J Can Dent Assoc. 2015;81:f20.
The management of patients on anticoagulation therapy is challenging. The objective of this study was to conduct a systematic review to establish the effectiveness of hemostatic interventions to prevent postoperative bleeding following dental extractions among patients taking warfarin.
A systematic review of the literature was conducted using PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases and applying relevant MeSH terms. Identified studies were screened independently by 2 reviewers using the following selection criteria: tooth extraction, patients taking warfarin as the only anticoagulant, randomized controlled trials and a hemostatic intervention.
Six articles were included in the final review, all evaluating different interventions. Oral or local hemostatic agents were compared in 4 studies where patients continued taking warfarin before and after the procedure; in 3 studies, there were no differences between the agents in preventing postoperative bleeding and, in 1, Histoacryl glue was superior to a gelatin sponge. Two studies compared warfarin continuation with temporary discontinuation and found that continuation did not increase the risk of bleeding in patients who had an international normalized ratio (INR) within the therapeutic range.
Patients with an INR within the therapeutic range can safely continue taking the regular dose of warfarin before dental extractions. There is no evidence to support or reject the superiority of local hemostatic agents over warfarin discontinuation.
对抗凝治疗患者的管理具有挑战性。本研究的目的是进行一项系统评价，以确定止血干预措施预防服用华法林患者拔牙后出血的有效性。
使用PubMed、EMBASE和Cochrane对照试验中央注册数据库对文献进行系统评价，并应用相关医学主题词。由2名评价者根据以下选择标准独立筛选纳入的研究：拔牙、服用华法林作为唯一抗凝剂的患者、随机对照试验和止血干预措施。
最终评价纳入6篇文章，均评估了不同的干预措施。4项研究比较了口服或局部止血剂，这些研究中的患者在手术前后继续服用华法林；在3项研究中，各止血剂在预防术后出血方面无差异，在1项研究中，Histoacryl胶优于明胶海绵。2项研究比较了华法林持续服用与暂时停药，发现对于国际标准化比值（INR）在治疗范围内的患者，持续服用不会增加出血风险。
INR在治疗范围内的患者在拔牙前可安全继续服用常规剂量的华法林。没有证据支持或反对局部止血剂优于停用华法林。
