Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8549, Japan.
Kubota Dental Clinic, 1-16-2 Iguchi, Mitaka, Tokyo, 181-0011, Japan.
Clin Oral Investig. 2023 Dec 26;28(1):22. doi: 10.1007/s00784-023-05424-1.
To investigate factors influencing postoperative bleeding occurrence after dental extraction in older patients receiving anticoagulation therapy.
This retrospective study included patients aged ≥ 65 years receiving one of the following anticoagulants: apixaban, edoxaban, rivaroxaban, and warfarin. Patients who underwent one to multiple tooth extractions in the geriatric dentistry clinic at Tokyo Medical and Dental University Hospital between August 1, 2016, and November 30, 2020, were included. The outcome variable was postoperative bleeding occurrence. Logistic regression analysis was performed with the following ten factors as explanatory variables: age, sex, maximum systolic blood pressure during the extraction, type of local anesthesia, vertical incision, osteotomy, usage of surgical splints, the mesiodistal width of the extracted tooth on a radiograph, use of antiplatelet agents, and history of diabetes requiring medication.
Among 395 participants (mean age, 82.3 ± 6.5 years) included in this study, 75 patients experienced postoperative bleeding after tooth extraction. Logistic regression analysis revealed that the odds ratios for the vertical incision (18.400, p < 0.001), osteotomy (3.630, p = 0.00558), usage of surgical splints (1.860, p = 0.0395), and the mesiodistal width of the extracted tooth on a radiograph (1.060, p = 0.0261) were statistically significant.
For dental extraction in older patients receiving anticoagulants, postoperative bleeding is more likely to occur in patients with vertical incision, osteotomy, and posterior or multiple tooth extractions.
Dentists should consider suturing and adjunctive hemostatic procedures for patients undergoing vertical incision, osteotomy, and multiple tooth extractions while receiving anticoagulation therapy to minimize the risk of postoperative bleeding.
调查接受抗凝治疗的老年拔牙术后出血发生的影响因素。
本回顾性研究纳入了 2016 年 8 月 1 日至 2020 年 11 月 30 日期间在东京医科齿科大学医院老年牙科诊所接受以下一种抗凝剂治疗的年龄≥65 岁的患者：阿哌沙班、依度沙班、利伐沙班和华法林。患者接受了一次或多次拔牙。将术后出血发生情况作为结局变量。采用逻辑回归分析，以以下 10 个因素作为解释变量：年龄、性别、拔牙期间的最大收缩压、局部麻醉类型、垂直切口、骨切开术、使用手术夹板、X 线片上拔牙的近远中宽度、使用抗血小板药物和需要药物治疗的糖尿病史。
在本研究纳入的 395 名参与者（平均年龄 82.3±6.5 岁）中，75 名患者在拔牙后出现术后出血。逻辑回归分析显示，垂直切口（18.400，p<0.001）、骨切开术（3.630，p=0.00558）、使用手术夹板（1.860，p=0.0395）和 X 线片上拔牙的近远中宽度（1.060，p=0.0261）的比值比有统计学意义。
对于接受抗凝治疗的老年患者的拔牙，垂直切口、骨切开术和后牙或多牙拔牙更有可能发生术后出血。
在接受抗凝治疗的患者中进行垂直切口、骨切开术和多牙拔牙时，牙医应考虑缝合和辅助止血措施，以最大程度地降低术后出血的风险。
