Tabrizi Reza, Khaheshi Isa, Hoseinzadeh Afshin, Rezvanpour Babak, Shafie Shervin
Associate Professor of Oral and Maxillofacial Surgery, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Assistant Professor of Cardiology, Cardiovascular Research Centre, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Oral Maxillofac Surg. 2018 Oct;76(10):2092-2096. doi: 10.1016/j.joms.2018.04.036. Epub 2018 May 10.
Cessation versus continuation of antiplatelet drugs in patients undergoing dental implant surgery is a controversial issue. The present study evaluated postoperative bleeding during and after dental implant surgery in patients taking aspirin (ASA) or clopidogrel.
The present study is a case-and-crossover study. Patients who were using antiplatelet drugs and receiving 2 bilateral dental implants in the posterior region of the mandible were studied. During session 1, dental implants were placed without stopping the intake of antiplatelet drugs. During session 2, antiplatelet drugs were stopped for 5 days. In group 1, platelet activity was measured by an assay based on flow cytometry and represented the platelet reactivity index. In group 2, platelet function analysis was used to monitor the antiplatelet effect of ASA. Bleeding severity was assessed using a visual analog scale for 72 hours after dental implant placement during sessions 1 and 2. Use of antiplatelet drugs was the predictive factor of the study and bleeding severity and platelet function were the outcomes of the study.
Twenty-two patients composed group 1 (clopidogrel 75 mg) and 20 composed group 2 (ASA 80 mg). In group 1, bleeding severity was 4.86 ± 0.77 during session 1 and 4.59 ± 0.66 during session 2. Data analysis showed no difference in bleeding severity between sessions 1 and 2 in group 1 (P = .72). In group 2, bleeding severity was 4.05 ± 0.94 during session 1 and 3.9 ± 0.85 during session 2. There was no difference in bleeding severity between sessions 1 and 2 in patients taking ASA (P = .19).
The results suggest that continuing the intake of antiplatelet drugs did not increase bleeding after placement of dental implants.
在接受牙种植手术的患者中，停用与继续使用抗血小板药物是一个有争议的问题。本研究评估了服用阿司匹林（ASA）或氯吡格雷的患者在牙种植手术期间及术后的出血情况。
本研究为病例交叉研究。研究对象为正在使用抗血小板药物且在下颌骨后部接受2颗双侧牙种植体植入的患者。在第1阶段，植入牙种植体时不停用抗血小板药物。在第2阶段，停用抗血小板药物5天。在第1组中，通过基于流式细胞术的检测方法测量血小板活性，并表示为血小板反应性指数。在第2组中，采用血小板功能分析来监测ASA的抗血小板作用。在第1阶段和第2阶段牙种植体植入后72小时，使用视觉模拟量表评估出血严重程度。抗血小板药物的使用是本研究的预测因素，出血严重程度和血小板功能是本研究的结果。
第1组有22例患者（氯吡格雷75毫克），第2组有20例患者（ASA 80毫克）。在第1组中，第1阶段的出血严重程度为4.86±0.77，第2阶段为4.59±0.66。数据分析显示第1组第1阶段和第2阶段之间的出血严重程度无差异（P = 0.72）。在第2组中，第1阶段的出血严重程度为4.05±0.94，第2阶段为3.9±0.85。服用ASA的患者第1阶段和第2阶段之间的出血严重程度无差异（P = 0.19）。
结果表明，继续服用抗血小板药物不会增加牙种植体植入后的出血情况。
