Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Clin Oral Investig. 2017 Sep;21(7):2183-2188. doi: 10.1007/s00784-016-2010-1. Epub 2016 Nov 28.
The aim of this study was to validate a standardized pragmatic approach to manage new oral anticoagulants (NOACs) in patients who undergo dental extractions.
This prospective case-control study in patients undergoing dental extraction included 26 patients (mean age 76 years, 57% male) treated with dabigatran, rivaroxaban, or apixaban and 26 matched controls. Regardless of timing of extraction, drug regimen, or renal function, patients were instructed to skip only the dose on the morning of the procedure. A procedural bleeding score was recorded and early and delayed bleeding was assessed at day 1 and day 7. Bleeding events were compared with a prospectively matched control group not taking any antithrombotic drug.
There was no difference in the procedural bleeding score or in early bleeding events (5 in both groups). However, delayed bleeding occurred more frequently in anticoagulated compared to non-anticoagulated patients (7 versus none, p = 0.01).
Skipping the morning dose of NOACs avoids excess bleeding during and early after the procedure. However, anticoagulated patients had an increased risk of delayed bleedings. Further study is needed to determine the optimal post-procedural management.
This is the first prospective study for the management of patients on NOACs undergoing dental extraction. Our pragmatic approach, omitting only a single morning dose, can guide clinical practice. Both patients and physicians should be aware of the increased delayed bleeding risk.
本研究旨在验证一种标准化的实用方法,以管理接受牙科拔牙手术的新型口服抗凝药物(NOAC)患者。
这项针对接受牙科拔牙手术患者的前瞻性病例对照研究纳入了 26 例(平均年龄 76 岁,57%为男性)接受达比加群、利伐沙班或阿哌沙班治疗的患者和 26 例匹配对照。无论拔牙时间、药物方案或肾功能如何,均指导患者仅跳过手术当天早上的剂量。记录了手术出血评分,并在第 1 天和第 7 天评估早期和迟发性出血。将出血事件与未服用任何抗血栓药物的前瞻性匹配对照组进行比较。
手术出血评分和早期出血事件无差异(两组均为 5 例)。然而,与未抗凝患者相比,抗凝患者更常发生迟发性出血(7 例 vs. 无,p=0.01)。
跳过 NOAC 的早晨剂量可避免手术期间和术后早期出现过度出血。然而,抗凝患者迟发性出血的风险增加。需要进一步研究以确定最佳的术后管理方法。
这是第一项针对接受 NOAC 治疗的患者进行牙科拔牙管理的前瞻性研究。我们的实用方法仅跳过单次早晨剂量,可以指导临床实践。患者和医生都应意识到增加的迟发性出血风险。