Professor, Department of Oral & Maxillofacial Surgey, JSS Dental College & Hospital, JSS AHER, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India.
Resident, Department of Oral & Maxillofacial Surgery, JSS Dental College & Hospital, JSS AHER, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India.
J Oral Maxillofac Surg. 2023 Feb;81(2):224-231. doi: 10.1016/j.joms.2022.10.011. Epub 2022 Oct 25.
Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics.
This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value ≤ 3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition.
Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86 years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96 ± 4 and 797 ± 23 seconds; P < .001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90 ± 6 and 109 ± 8 seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940 ± 20 and 726 ± 26 seconds; P < .001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r = 0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs.
When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.
拔牙会导致出血，在服用抗血栓药物的患者中出血时间可能更长。本研究旨在评估壳聚糖敷料在接受单一或双重抗血栓药物治疗的患者拔牙后的止血和伤口愈合效果与棉压包相比。
这是一项前瞻性、随机分组的对口研究。2020 年 2 月至 2022 年 1 月，在印度迈索尔的 JSS 牙科医学院和医院招募了正在服用单一或双重抗血栓药物且国际标准化比值（INR）值≤3 的接受拔牙的患者。该研究比较了壳聚糖敷料在实现更快止血方面的效果，与棉压包相比。主要结果是达到止血的时间，次要结果是牙槽临床愈合指数和牙槽骨炎。协变量为性别、年龄、拔牙原因、INR、抗血栓治疗类型和疾病状况。
在 54 名入组的受试者中，39 名为男性，15 名为女性，年龄在 33 岁至 86 岁之间。36 名患者服用单一抗血栓药物，18 名患者服用双重抗血栓药物。拔牙的原因是牙周炎 37 例，龋齿 17 例。达到止血的时间用壳聚糖牙敷料比用棉压包更短（96±4 和 797±23 秒；P<0.001）。在壳聚糖组中，无论使用单一还是双重抗血栓治疗，达到止血的时间相似（分别为 90±6 和 109±8 秒）。相反，在棉压包组中，服用双重抗血栓药物的患者达到止血的时间比服用单一抗血栓药物的患者长（940±20 和 726±26 秒；P<0.001）。达到止血的时间仅在棉压包组中与 INR 相关（r=0.7756）。用壳聚糖治疗的患者中牙槽临床愈合指数更好，为 88.9%，而用棉压包的患者只有 3.7%。用壳聚糖治疗的患者无一例出现牙槽骨炎，而用棉压包的患者有 3.7%出现。
与棉压包相比，壳聚糖敷料在接受单一和双重抗血栓药物治疗的患者中更有效地控制术后出血。
