Campana Maria Domenica, Aliberti Angelo, Acerra Alfonso, Sammartino Pasquale, Dolce Pasquale, Sammartino Gilberto, Gasparro Roberta
Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy.
Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
J Clin Med. 2023 Aug 17;12(16):5342. doi: 10.3390/jcm12165342.
One of the common challenges in oral surgery is dealing with patients who are taking oral anticoagulant/antiaggregant drugs. Several local hemostatic agents have been proposed as an alternative to conventional suturing. Among these, autologous platelet concentrates (APCs) have been widely used to decrease the risk of hemorrhage after dental extraction. Nevertheless, there is a lack of consensus regarding the superiority of any one specific hemostatic agent over the others. This systematic review is aimed at evaluating the effectiveness of APCs as hemostatic agents after tooth extraction in patients on anticoagulant therapy. A literature search was conducted of articles published before March 2023 on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies on the use of APCs in patients undergoing dental extractions and being treated with anticoagulant drugs were included. Only randomized, controlled trials (RCTs) published up to March 2023 were included; the outcomes assessed were the time to hemostasis, the presence of post-operative bleeding and pain, and the effectiveness of wound healing. The risk of bias for each RCT was assessed by using the 'risk of bias' tool (RoB 1.0). The research revealed 6 RCTs. The findings indicated that patients on anticoagulant therapy who received APCs without discontinuing their medication experienced a decreased post-operative bleeding, a shorter hemostasis time, reduced pain, and accelerated wound healing. However, due to the high/unclear risk of bias of the studies included, no definitive conclusions can be drawn on the superiority of APCs as hemostatic agents over other similar products. Additional studies are required to validate these findings.
口腔外科常见的挑战之一是应对正在服用口服抗凝剂/抗血小板药物的患者。已提出几种局部止血剂作为传统缝合的替代方法。其中，自体血小板浓缩物（APCs）已被广泛用于降低拔牙后出血的风险。然而，对于任何一种特定止血剂是否优于其他止血剂，目前尚无共识。本系统评价旨在评估APCs作为抗凝治疗患者拔牙后止血剂的有效性。对2023年3月之前发表在PubMed、Scopus和Cochrane对照试验中央登记册（CENTRAL）上的文章进行了文献检索。纳入了关于在接受拔牙且正在接受抗凝药物治疗的患者中使用APCs的研究。仅纳入截至2023年3月发表的随机对照试验（RCTs）；评估的结果包括止血时间、术后出血和疼痛情况以及伤口愈合的有效性。使用“偏倚风险”工具（RoB 1.0）评估每个RCT的偏倚风险。该研究共发现6项RCTs。研究结果表明，接受APCs且不停用药物的抗凝治疗患者术后出血减少、止血时间缩短、疼痛减轻且伤口愈合加快。然而，由于所纳入研究的偏倚风险高/不明确，无法就APCs作为止血剂相对于其他类似产品的优越性得出明确结论。需要更多研究来验证这些发现。
