Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
Department of Oral and Maxillofacial Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan.
BMJ Open. 2017 Aug 21;7(8):e015952. doi: 10.1136/bmjopen-2017-015952.
The effect of direct oral anticoagulants (DOACs) on the risk of bleeding after tooth extraction remains unclear. This study aimed to evaluate the incidence of postextraction bleeding among patients who received DOAC and vitamin K antagonists (VKAs), such as warfarin.
This study was a retrospective cohort analysis. Incidence rates and propensity score-matched regression models were used to compare the risks of bleeding after tooth extractions involving DOACs and VKAs.
The study took place in a single university hospital in Japan.
Between April 2013 and April 2015, 543 patients underwent a total of 1196 simple tooth extractions.
The primary outcome measure was the occurrence of postextraction bleeding, which was defined as bleeding that could not be stopped by biting down on gauze and required medical treatment between 30 min and 7 days after the extraction.
A total of 1196 tooth extractions (634 procedures) in 541 patients fulfilled the study criteria, with 72 extractions (41 procedures) involving DOACs, 100 extractions (50 procedures) involving VKAs and 1024 extractions (543 procedures) involving no anticoagulants. The incidences of postextraction bleeding per tooth for the DOAC, VKA and no anticoagulant extractions were 10.4%, 12.0% and 0.9%, respectively. The incidences of postextraction bleeding per procedure for DOACs, VKAs and no anticoagulants were 9.7%, 10.0% and 1.1%, respectively. In comparison to the VKA extractions, the DOAC extractions did not significantly increase the risk of postextraction bleeding (OR 0.69, 95% CIs 0.24 to 1.97; p=0.49).
The risk of postextraction bleeding was similar for DOAC and VKA extractions.
直接口服抗凝剂（DOACs）对拔牙后出血风险的影响仍不清楚。本研究旨在评估接受 DOAC 和维生素 K 拮抗剂（VKA）（如华法林）的患者拔牙后出血的发生率。
本研究为回顾性队列分析。使用发病率和倾向评分匹配回归模型比较了 DOAC 和 VKA 拔牙后出血的风险。
研究在日本的一家大学医院进行。
2013 年 4 月至 2015 年 4 月，543 例患者共进行了 1196 例简单拔牙。
主要结局测量是拔牙后出血的发生，定义为拔牙后 30 分钟至 7 天内无法用纱布咬住止血且需要治疗的出血。
共有 541 例患者的 1196 例拔牙（634 例）符合研究标准，其中 72 例（41 例）涉及 DOAC，100 例（50 例）涉及 VKA，1024 例（543 例）不涉及抗凝剂。DOAC、VKA 和无抗凝剂拔牙的每颗牙拔牙后出血发生率分别为 10.4%、12.0%和 0.9%。DOAC、VKA 和无抗凝剂拔牙的每例手术拔牙后出血发生率分别为 9.7%、10.0%和 1.1%。与 VKA 拔牙相比，DOAC 拔牙并未显著增加拔牙后出血的风险（OR 0.69，95%CI 0.24 至 1.97；p=0.49）。
DOAC 和 VKA 拔牙后出血的风险相似。
