Department of Dentistry and Oral Surgery, National Center for Geriatrics and Gerontology, Aichi, Japan.
Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Hyogo, Japan.
Gerodontology. 2024 Jun;41(2):269-275. doi: 10.1111/ger.12703. Epub 2023 Jul 19.
Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size.
This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database.
Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post-extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables.
Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00-9.02).
The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.
有几项研究调查了抗血栓治疗患者拔牙后的出血情况，但大多数研究的样本量都较小。
本研究旨在利用大型数据库中的数据分析抗血栓治疗患者拔牙后的出血情况。
纳入了一项大型多区域队列研究（长寿改善和公平证据研究）中 2014 年 10 月至 2019 年 3 月间接受拔牙治疗的医疗保险和晚期老年医疗保健系统参保者（n=107767）的理赔数据。根据拔牙时使用的药物代码（分为六组：无抗血栓治疗、单一抗血小板治疗、双重抗血小板治疗、直接口服抗凝剂、华法林和联合抗血小板和抗凝治疗）确定抗血栓治疗情况。结果定义为拔牙当月“拔牙后出血”作为疾病名称的存在。为了详细检查抗血栓治疗与拔牙后出血之间的关系，我们将拔牙后出血作为因变量，每种抗血栓治疗作为解释变量，年龄、性别和合并症作为调整变量，进行多因素逻辑回归分析。
14343 名患者（13.3%）接受了抗血栓治疗，419 名患者（0.4%）发生了拔牙后出血。与其他组相比，无抗血栓治疗和单一抗血小板治疗组的拔牙后出血发生率显著较低（比值比：2.00-9.02）。
抗凝或双重抗血栓治疗患者拔牙后出血的频率较高。因此，这些患者在拔牙前需要进行仔细的准备。
