Department of Advanced General Dentistry, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Clin Oral Investig. 2019 Jan;23(1):477-484. doi: 10.1007/s00784-018-2458-2. Epub 2018 Apr 25.
Several novel oral anticoagulants (NOACs) are currently prescribed for patients suffering from atrial fibrillation, pulmonary thromboembolism, and venous thrombosis. However, there is no clinical guideline for dental treatment in patients taking NOACs. This study investigated bleeding events related to various dental treatments.
This retrospective study included 120 patients (153 cases) who were prescribed NOACs and received dental procedures in the Department of Advanced General Dentistry at Yonsei University Dental Hospital from January 2014 to June 2017. The indication for NOACs, initiation of NOACs, duration of discontinuance, creatinine clearance, and type of dental treatment were investigated. Bleeding events were assessed at a follow-up visit to the clinic.
Postoperative bleeding occurred in only 9 of the 153 included cases; they comprised 2 cases of scaling, 3 cases of simple extraction, 3 cases of the first stage of implant surgery, and 1 case of resin filling. The creatinine clearance (P = .111) and duration of discontinuance (P = .222) did not differ significantly between the groups with and without bleeding events.
Our data indicate that most dental treatments may be performed in patients taking NOACs without an increased likelihood of bleeding events regardless of the discontinuance duration. Moreover, any postoperative bleeding can be stopped by applying compressive pressure or local hemostatic agents.
Our study suggests that patients taking NOACs who need dental treatments may have a bleeding tendency based on our retrospective data. Preoperative history taking and treatment modification should therefore be considered before performing dental surgery.
目前，几种新型口服抗凝剂（NOAC）被用于治疗房颤、肺血栓栓塞和静脉血栓形成的患者。然而，对于服用 NOAC 的患者，目前尚无牙科治疗的临床指南。本研究调查了与各种牙科治疗相关的出血事件。
本回顾性研究纳入了 2014 年 1 月至 2017 年 6 月期间在延世大学牙科医院高级综合牙科就诊并接受牙科治疗的 120 例（153 例）服用 NOAC 的患者。研究调查了服用 NOAC 的适应证、NOAC 的起始时间、停药时间、肌酐清除率和牙科治疗类型。通过门诊随访评估出血事件。
仅 153 例纳入病例中有 9 例发生术后出血；其中 2 例为洁牙，3 例为简单拔牙，3 例为种植手术第一阶段，1 例为树脂填充。有出血事件组和无出血事件组的肌酐清除率（P = .111）和停药时间（P = .222）无显著差异。
我们的数据表明，大多数牙科治疗在服用 NOAC 的患者中进行时，出血事件的发生风险不会增加，无论停药时间长短。此外，通过施加压迫或局部止血剂可停止任何术后出血。
根据我们的回顾性数据，我们的研究表明，需要牙科治疗的服用 NOAC 的患者可能存在出血倾向。因此，在进行牙科手术前，应进行术前病史采集和治疗方案调整。
