Chahine Johnny, Khoudary Marwan N, Nasr Samer
Department of Internal Medicine, Cleveland Clinic Foundation Fairview Hospital, Cleveland, OH, USA.
Department of Conventional and Surgical Endodontics, Senior Instructor, St Joseph University, Beirut, Lebanon.
Cardiol Res Pract. 2019 Jun 2;2019:9308631. doi: 10.1155/2019/9308631. eCollection 2019.
Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.
目前，接受口服抗凝治疗的患者数量正在增加。关于在特定牙科手术前后维持口服抗凝治疗（尤其是新型口服抗凝药）的数据较少。牙医有三种选择：要么停止抗凝，要么继续抗凝，要么用肝素进行桥接抗凝。为解决这一问题，对10项临床试验进行了系统评价。结果发现，在大多数试验中，牙科手术期间继续抗凝不会增加出血风险。尽管没有研究报告抗凝中断后发生血栓栓塞事件，但随访期较短且不一致，而且停止抗凝时血栓栓塞风险增加在文献中是众所周知的。肝素桥接抗凝与出血发生率增加有关。我们建议，对于绝大多数牙科手术，在使用局部止血剂的同时，使用维生素K拮抗剂和新型口服抗凝药维持口服抗凝治疗。
