Wahl M J
Department of Dentistry, Christiana Care Health Services, Wilmington, Del, USA.
Arch Intern Med. 1998;158(15):1610-6. doi: 10.1001/archinte.158.15.1610.
Continuous oral anticoagulant therapy has been used to decrease the risk of thromboembolism for more than half a century, prolonging the lives of thousands of patients. Many physicians recommend interrupting continuous anticoagulant therapy for dental surgery to prevent hemorrhage. In reviewing the available literature, there are no well-documented cases of serious bleeding problems from dental surgery in patients receiving therapeutic levels of continuous warfarin sodium therapy, but there were several documented cases of serious embolic complications in patients whose warfarin therapy was withdrawn for dental treatment. Many authorities state that dental extractions can be performed with minimal risk in patients who are at or above therapeutic levels of anticoagulation. There are sound legal reasons to continue therapeutic levels of warfarin for dental treatment. Although there is a theoretical risk of hemorrhage after dental surgery in patients who are at therapeutic levels of anticoagulation, the risk appears to be minimal, the bleeding usually can be easily treated with local measures, and this risk may be greatly outweighed by the risk of thromboembolism after withdrawal of anticoagulant therapy.
持续口服抗凝治疗已被用于降低血栓栓塞风险半个多世纪，挽救了成千上万患者的生命。许多医生建议在牙科手术时中断持续抗凝治疗以预防出血。在查阅现有文献时，接受治疗剂量持续华法林钠治疗的患者中，没有充分记录的牙科手术严重出血问题病例，但有几例记录在案的患者因牙科治疗停用华法林治疗后出现严重栓塞并发症的病例。许多权威人士指出，处于或高于抗凝治疗水平的患者进行拔牙时风险极小。有充分的法律理由在牙科治疗时维持华法林的治疗剂量。虽然处于抗凝治疗水平的患者牙科手术后理论上存在出血风险，但这种风险似乎极小，出血通常可用局部措施轻松治疗，而且这种风险可能远低于停用抗凝治疗后发生血栓栓塞的风险。
