Morimoto Yoshinari, Yokoe Chizuko, Imai Yuko, Sugihara Megumi, Futatsuki Toshiko
Department of Anesthesiology, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan.
Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan.
J Dent Sci. 2016 Mar;11(1):59-64. doi: 10.1016/j.jds.2015.09.002. Epub 2015 Nov 18.
BACKGROUND/PURPOSE: The nonvitamin K antagonist oral anticoagulants direct-thrombin inhibitor dabigatran and the Xa inhibitors rivaroxaban and apixaban are now being used clinically. The course of the patients on these anticoagulants who underwent tooth extraction was assessed.
The medical charts of these patients were investigated. Tooth extraction was performed while maintaining conventional anticoagulant therapy.
Twenty-three teeth were extracted in 19 patients, including two surgical extractions. Among the 19 patients, nine patients ingested rivaroxaban, six apixaban, and four dabigatran. One patient on rivaroxaban showed persistent postoperative bleeding following two surgical extractions. Mild oozing was observed in five patients (two on rivaroxaban and three on apixaban). There was no bleeding episode in the patients on dabigatran.
The patients on rivaroxaban with a prolonged prothrombin time value have a higher risk of bleeding, especially undergoing surgical extraction. Apixaban correlates to neither activated partial thromboplastin time nor prothrombin time values and the countermeasures should be employed based on the clinical findings.
背景/目的：非维生素K拮抗剂口服抗凝药直接凝血酶抑制剂达比加群以及Xa因子抑制剂利伐沙班和阿哌沙班目前正在临床使用。对接受拔牙手术的使用这些抗凝药的患者病程进行了评估。
对这些患者的病历进行了调查。在维持常规抗凝治疗的同时进行拔牙手术。
19例患者共拔除23颗牙齿，其中包括2例外科拔牙。19例患者中，9例服用利伐沙班，6例服用阿哌沙班，4例服用达比加群。1例服用利伐沙班的患者在两次外科拔牙后出现持续性术后出血。5例患者（2例服用利伐沙班，3例服用阿哌沙班）出现轻微渗血。服用达比加群的患者未发生出血事件。
凝血酶原时间值延长的服用利伐沙班的患者出血风险较高，尤其是接受外科拔牙时。阿哌沙班与活化部分凝血活酶时间和凝血酶原时间值均无相关性，应根据临床发现采取相应对策。
