Lombardi Niccolò, Varoni Elena M, Sorrentino Daniela, Lodi Giovanni
ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Odontostomatologia II Clinical Unit, Milan, Italy.
Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy.
Spec Care Dentist. 2020 Jul;40(4):374-381. doi: 10.1111/scd.12485. Epub 2020 Jun 7.
Dental extractions can be safely carried out on patients under vitamin K antagonists (VKAs) therapy, without stopping or changing the dosage, but the international normalized ratio (INR) needs to be monitored on the day of the intervention, showing adequate rates before proceeding.
This study aims at evaluating INR values, measured before oral surgery procedures, to assess the rate of patients, under VKAs therapy, outside the therapeutic range.
A clinical audit was carried out involving patients under VKAs, who needed minor oral surgery procedures, over a period of 18 months. The patient was instructed to not modify or suspend VKAs prior to the intervention. Before surgery, each patient fulfilled a questionnaire on dietary and oral hygiene habits, and a blood sample was collected for INR assessment (cut-off value for surgical procedure ≤3.5).
One hundred twenty-two patients were enrolled: 69 (56.6%) had an INR value within the established therapeutic range, 53 (43.4%) were out of range. No intra- or postsurgical major bleeding was recorded.
INR, measured on the same day of oral surgery, has the potential to prevent bleeding complications by the identification of those patients out of range, who may require adjusting the drug therapeutic dosage.
在接受维生素K拮抗剂（VKA）治疗的患者中，可以在不停用或改变剂量的情况下安全地进行拔牙，但在干预当天需要监测国际标准化比值（INR），在进行手术前要显示出适当的比率。
本研究旨在评估口腔外科手术前测量的INR值，以评估接受VKA治疗的患者超出治疗范围的比率。
进行了一项临床审计，涉及在18个月期间需要进行小型口腔外科手术的接受VKA治疗的患者。患者被指示在干预前不要改变或停用VKA。手术前，每位患者填写一份关于饮食和口腔卫生习惯的问卷，并采集血样进行INR评估（手术的临界值≤3.5）。
共纳入122例患者：69例（56.6%）的INR值在既定治疗范围内，53例（43.4%）超出范围。未记录到手术中或手术后的大出血情况。
在口腔手术当天测量的INR，有可能通过识别超出范围的患者来预防出血并发症，这些患者可能需要调整药物治疗剂量。
