Igelbrink Sebastian, Burghardt Stefan, Michel Barbara, Kübler Norbert R, Holtmann Henrik
Clinic for Oral and Maxillofacial Surgery, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
Clinic for Oral and Maxillofacial Surgery, University Clinic of Duesseldorf, Moorenstr 5, 40225 Duesseldorf, Germany.
Int J Dent. 2018 Jun 3;2018:6595406. doi: 10.1155/2018/6595406. eCollection 2018.
Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other.
The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients.
The vast majority of patients took a coumarin derivative (41) and acetylsalicylic acid (27). Nine (12%) of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s).
Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90%) can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s), and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.
牙科手术后出血仍是使用抗凝剂患者紧急就诊的常见原因。我们的目的一方面是分析相关特征，另一方面是揭示处理中存在的问题。
该研究纳入了76例患者。我们记录了各患者的基本数据、抗凝药物、手术类型和牙槽窝缝合情况。
绝大多数患者服用香豆素衍生物（41例）和乙酰水杨酸（27例）。尽管采取了局部止血措施和/或循环调节措施，仍有9例（12%）患者因持续出血而不得不住院。大多数患者可在门诊成功治疗。出血、国际标准化比值（INR）水平、拔牙数量和缝合牙槽之间未显示出统计学上的显著相关性。65%的拔牙病例未进行牙槽窝缝合。87%的患者否认其外科医生/牙医告知过他们可能的自我治疗选择，且没有患者得到术前制作的绷带板。
目前服用香豆素衍生物的患者是牙槽外科手术后抗凝剂引起出血的最大群体。大部分术后出血（90%）可通过最简单的外科干预在门诊处理。不幸的是，大部分患者群体未进行缝合，未得到预制牙科绷带板，且其牙医未就术后出血的处理方法进行解释。因此，牙科医生应进一步了解如何预防术后出血情况。
