Dinkova Atanaska S, Atanasov Dimitar T, Vladimirova-Kitova Ludmila G
Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
Section of Cardiology, First Department of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, Bulgaria
Folia Med (Plovdiv). 2017 Sep 1;59(3):336-343. doi: 10.1515/folmed-2017-0043.
The risk of excessive bleeding often prompts physicians to interrupt the antiplatelet agents as acetylsalicilyc acid and clopidogrel before dental extractions which puts patients at risk of adverse thrombotic events.
To assess the bleeding risk during dental extractions in patients with continued antiplatelet therapy.
The study included 130 patients (64 men and 66 women) aged between 18 and 99 years old. Sixty-eight of the patients received 100 mg acetilsalicilic acid (ASA); these were divided into two groups: 34 patients continued taking ASA and 34 patients stopped it 72 hours before extraction. Sixty-two of the patients were treated with 75 mg clopidogrel; these were also divided into two groups: 31 continued taking clopidogrel and 31 patients stopped it 72 hours before extractions. Extraction was performed under local anaesthesia as no more than 3 teeth per visit were extracted. Local haemostasis with gelatine sponge and/or suturing was used to control bleeding.
Mild bleeding was observed most frequently in the first 30 minutes, successfully managed by local haemostasis. Only 1 patient in the control and 1 in the experimental group receiving ASA reported mild bleeding in the first 24 hours, controlled by compression with gauze. No major haemorrhage requiring emergency or more than local haemostasis occurred. No statistically significant difference in bleeding between two groups was found.
Single and multiple dental extractions in patients receiving acetylsalicylic acid or clopidogrel can be safely performed without discontinuation of the therapy with provided appropriate local haemostasis.
出血风险过高常常促使医生在拔牙前中断使用乙酰水杨酸和氯吡格雷等抗血小板药物，这会使患者面临不良血栓事件的风险。
评估持续进行抗血小板治疗的患者在拔牙过程中的出血风险。
该研究纳入了130名年龄在18至99岁之间的患者（64名男性和66名女性）。其中68名患者服用100毫克乙酰水杨酸（ASA）；这些患者被分为两组：34名患者继续服用ASA，34名患者在拔牙前72小时停药。62名患者接受75毫克氯吡格雷治疗；这些患者也被分为两组：31名继续服用氯吡格雷，31名患者在拔牙前72小时停药。由于每次就诊拔牙不超过3颗，拔牙在局部麻醉下进行。使用明胶海绵和/或缝合进行局部止血以控制出血。
轻度出血最常出现在最初30分钟内，通过局部止血成功处理。在对照组和接受ASA治疗的实验组中，只有1名患者在最初24小时内报告有轻度出血，通过纱布压迫得以控制。未发生需要紧急处理或超过局部止血范围的大出血。两组之间在出血方面未发现统计学上的显著差异。
接受乙酰水杨酸或氯吡格雷治疗的患者进行单颗或多颗牙齿拔除时，在采取适当局部止血措施的情况下，可以在不停用治疗药物的情况下安全进行。
