Kataoka Toshiyuki, Hoshi Keika, Ando Tomohiro
Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Department of Hygiene, School of Medicine, Kitasato University, Kanagawwa, Japan.
BMJ Open. 2016 Mar 2;6(3):e010471. doi: 10.1136/bmjopen-2015-010471.
Unexpected post-extraction bleeding is often experienced in clinical practice. Therefore, determining the risk of post-extraction bleeding in patients receiving anticoagulant therapy prior to surgery is beneficial. This study aimed to verify whether the HAS-BLED score was useful in predicting post-extraction bleeding in patients taking warfarin.
Retrospective cohort study.
Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University.
Participants included 258 sequential cases (462 teeth) who had undergone tooth extraction between 1 January 2010 and 31 December 2012 while continuing warfarin therapy.
Post-extraction risk factors for bleeding. The following data were collected as the predicting variables for multivariate logistic analysis: the HAS-BLED score, extraction site, tooth type, stability of teeth, extraction procedure, prothrombin time-international normalised ratio value, platelet count and the use of concomitant antiplatelet agents.
Post-extraction bleeding was noted in 21 (8.1%) of the 258 cases. Haemostasis was achieved with localised haemostatic procedures in all the cases of post-extraction bleeding. The HAS-BLED score was found to be insufficient in predicting post-extraction bleeding (area under the curve=0.548, p=0.867, multivariate analysis). The risk of post-extraction bleeding was approximately three times greater in patients taking concomitant oral antiplatelet agents (risk ratio=2.881, p=0.035, multivariate analysis).
The HAS-BLED score alone could not predict post-extraction bleeding. The concomitant use of oral antiplatelet agents was a risk factor for post-extraction bleeding. No episodes of post-extraction bleeding required more than local measures for haemostasis. However, because this was a retrospective study conducted at a single institution, large-scale prospective cohort studies, which include cases of outpatient tooth extraction, will be necessary in the future.
临床实践中经常会遇到拔牙后意外出血的情况。因此，在手术前确定接受抗凝治疗的患者拔牙后出血的风险是有益的。本研究旨在验证HAS - BLED评分是否有助于预测服用华法林患者的拔牙后出血情况。
回顾性队列研究。
东京女子医科大学口腔颌面外科。
参与者包括2010年1月1日至2012年12月31日期间在继续服用华法林治疗的同时接受拔牙的258例连续病例（462颗牙齿）。
拔牙后出血的危险因素。收集以下数据作为多因素逻辑分析的预测变量：HAS - BLED评分、拔牙部位、牙齿类型、牙齿稳定性、拔牙程序、凝血酶原时间 - 国际标准化比值、血小板计数以及是否使用抗血小板药物。
258例病例中有21例（8.1%）出现拔牙后出血。所有拔牙后出血病例均通过局部止血措施实现止血。发现HAS - BLED评分在预测拔牙后出血方面不足（曲线下面积 = 0.548，p = 0.867，多因素分析）。服用口服抗血小板药物的患者拔牙后出血风险大约高出三倍（风险比 = 2.881，p = 0.035，多因素分析）。
仅HAS - BLED评分无法预测拔牙后出血。口服抗血小板药物的联合使用是拔牙后出血的一个危险因素。所有拔牙后出血病例均仅需局部止血措施。然而，由于这是在单一机构进行的回顾性研究，未来有必要开展大规模前瞻性队列研究，包括门诊拔牙病例。
