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双联抗血小板治疗患者拔牙时出血量的量化分析

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy.

作者信息

Buhatem Medeiros F, Pepe Medeiros de Rezende N, Bertoldi Franco J, Porrio de Andrade A C, Timerman L, Gallottini M, Itagiba Neves I L, Ortega K L

机构信息

School of Dentistry, Department of Oral Pathology, University of São Paulo, São Paulo, Brazil.

Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil.

出版信息

Int J Oral Maxillofac Surg. 2017 Sep;46(9):1151-1157. doi: 10.1016/j.ijom.2017.05.013. Epub 2017 Jun 12.

Abstract

In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case-control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

摘要

尽管有引发血栓栓塞事件的可能性,但许多专业人士仍建议在牙科手术前停用抗血小板药物。本研究的目的是对接受双重抗血小板治疗的患者术中出血情况进行定量评估。对接受双重抗血小板治疗的患者(APT组)和未使用这些药物的患者(对照组)进行了一项病例对照研究。要求进行以下检查:全血细胞计数、凝血试验和血小板聚集试验。术中通过收集吸出的血液来测量出血量。对照组手术过程中的平均失血量为6.10ml,APT组为16.07ml(P = 0.002)。对照组每分钟的平均失血量为0.60ml/分钟,APT组为1ml/分钟(P = 0.001),局部止血方法足以控制出血。在任何情况下均无术后出血并发症。接受双重抗血小板治疗的患者出血量较大,但可通过局部止血措施加以控制。因此,在拔牙前无需停用双重抗血小板治疗的两种药物中的任何一种。

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