Hoda Md Mahbubul, Navaneetham Romir, Sham M E, Menon Suresh, Kumar Veerendra, Archana S
Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India.
Ann Maxillofac Surg. 2021 Jan-Jun;11(1):75-79. doi: 10.4103/ams.ams_406_20. Epub 2021 Jul 24.
Patients with ischemic heart disease are placed on antiplatelet therapy (APT). This study allows a definite protocol to be set which will allow us the make the right judgment when it comes to extractions in patients on APT.
For this study, 100 patients were taken up for dental extraction after obtaining a thorough case history. Bleeding time was assessed preoperatively for all the patients and patients with normal bleeding time were taken up for surgery under local anesthesia. Local haemostatic measures were employed after the extraction. Patients were monitored for first 30 minutes at the clinic and a telephonic review of all the patients was done at 24 h-48 h interval after the procedure. If there was an active ooze from the surgical site at any point, haemostatic measures with local haemostatic agents were carried out.
In patients with mono antiplatelet therapy, bleeding was noted in 16 patients after the 1 h time interval and was absent after 24h-48 h time intervals. The = 32 and the < 0.001, making it statistically significant. Regarding patients on dual APT, bleeding was noted in ten patients after 1 h, and in one patient after 24 h with no patients presenting with bleeding at the 48 h time interval. The = 16.545 and < 0.001, making it statistically significant.
The benefits of continuing APT for patients who require dental extraction outweighs the risks of postoperative bleeding.
Antiplatelets are used for the prevention of myocardial infarction, ischemic stroke, and vascular death among patients who are at high risk of these events. Antiplatelets have minimal impact on the amount and duration of bleeding following routine dental extractions.
缺血性心脏病患者需接受抗血小板治疗（APT）。本研究制定了明确的方案，以便我们在为接受APT治疗的患者拔牙时能做出正确判断。
本研究选取了100例患者，在详细了解病史后进行拔牙。术前对所有患者评估出血时间，出血时间正常的患者在局部麻醉下进行手术。拔牙后采取局部止血措施。患者在诊所接受首30分钟的监测，并在术后24至48小时进行电话随访。若手术部位在任何时候出现活动性渗血，则使用局部止血剂进行止血措施。
接受单一抗血小板治疗的患者中，1小时后有16例出现出血，而在24至48小时后未再出血。χ² = 32，P < 0.001，具有统计学意义。对于接受双重APT治疗的患者，1小时后有10例出血，24小时后有1例出血，48小时时无患者出血。χ² = 16.545，P < 0.001，具有统计学意义。
对于需要拔牙的患者，继续进行APT治疗的益处大于术后出血风险。
抗血小板药物用于预防心肌梗死、缺血性中风以及这些事件高风险患者的血管性死亡。抗血小板药物对常规拔牙后的出血量和出血持续时间影响极小。
