Vangelisti R, Pagnacco O, Ristagno G, Ruggeri M, Tosetto A, Castaman G, Rodeghiero F
Servizio di Odontoiatria, Ospedale di Sandrigo, Vicenza.
Minerva Stomatol. 1997 Nov;46(11):621-6.
The physiopathology of the hemorrhagic blood coagulation disorders caused by genetic or aquired problems is described. Among the former the most frequent ones include the hemophilia of type A-B and the von Willebrand disease, among the latter the use of oral anticoagulant constitutes the most frequent cause. If the are not subjected to an adequate haemostatic prophylaxis, both patients with hemophilia and von Willebrand disease present a serious haemorrhagic risk as a consequence of dental practice. As far as the use of anticoagulants is concerned, a periodical monitoring of the time of prothrombin (PT) is needed to find the right dosage (TP between 20%-30% or INR--international normalized radio between 2 and 3.5). Values over this range cause an increase of the hemorrhagic risk, while lower values involve an increased risk of thrombotic events. According to the authors the patients with the hemorrhagic diathesis show a precise handicap, caused both by his illness and by environmental elements, such as the fear of doctors for the haemorrhagic complications consequent to a therapeutical operation, fear that often leads to neglect important medical measures, in particular dental measures. The specialized dental surgeon has to mantain a strict cooperation with the hematologist in order to arrange an appropriate procedure of the prophylaxis. As far as the hemostatic prophylaxis is concerned, the use of the dermopressin (DDAVP), in patients with hemophilia A and von Willebrand disease, guarantees the realisation of dental practice without hemorrhagic risk. On the contrary, the use of the tranhexanic acid on patients in an anticoagulant oral treatment gives hemostatic security and makes it possible to carry on the therapy and the out-patient treatment.
本文描述了由遗传或后天问题引起的出血性凝血障碍的生理病理学。在前者中，最常见的包括A - B型血友病和血管性血友病，在后者中，使用口服抗凝剂是最常见的原因。如果血友病和血管性血友病患者没有接受充分的止血预防措施，由于牙科操作，他们都面临严重的出血风险。就抗凝剂的使用而言，需要定期监测凝血酶原时间（PT）以确定正确的剂量（PT在20% - 30%之间或国际标准化比值INR在2至3.5之间）。超过此范围的值会增加出血风险，而较低的值则会增加血栓形成事件的风险。据作者称，出血素质患者表现出明确的障碍，这是由其疾病以及环境因素造成的，例如医生担心治疗性手术导致的出血并发症，这种担心往往导致忽视重要的医疗措施，尤其是牙科措施。专业牙科外科医生必须与血液学家保持密切合作，以安排适当的预防程序。就止血预防而言，对于A型血友病和血管性血友病患者，使用去氨加压素（DDAVP）可确保在无出血风险的情况下进行牙科操作。相反，对于接受口服抗凝治疗的患者使用氨甲环酸可提供止血保障，并使继续治疗和门诊治疗成为可能。
