Troulis M J, Head T W, Leclerc J R
Division of Oral and Maxillofacial Surgery, The Montreal General Hospital, McGill University, Quebec, Canada.
J Oral Maxillofac Surg. 1998 Aug;56(8):914-7; discussion 917-8. doi: 10.1016/s0278-2391(98)90647-4.
The World Health Organization (WHO) recommends the use of the International Normalized Ratio (INR) for reporting prothrombin time (PT) values. However, there are no scientifically based guidelines for performing dental extractions when using the INR. Oral and maxillofacial surgeons were surveyed to determine whether the INR is the method they use to monitor the level of anticoagulation and to determine what protocols are followed when anticoagulated patients require dental extractions.
A mail survey of academic oral and maxillofacial surgeons in North America was conducted to determine their choice of laboratory tests for assessing patients on oral anticoagulants and their protocol before proceeding to dental extractions.
Fifty-three of 73 respondents (73%) routinely use the INR, but only 21% rely on this method alone. Twelve percent and 11% of respondents, respectively, also use the PT value and PT ratio. The level of anticoagulation at which surgeons would proceed with dental extractions was variable. For those using the INR, it was from 1.3 to 4.0, for those using PT ratios the perceived safe range was from 1.0 to 2.0, and for those using the PT value, the range was from 13 to 21 sec.
Despite the support in the medical literature for use of the INR, many oral and maxillofacial surgeons still use the PT for monitoring oral anticoagulant therapy. There is no consensus on the INR interval at which dental extractions can be safely performed. Prospective studies are needed in this area.
世界卫生组织（WHO）推荐使用国际标准化比值（INR）来报告凝血酶原时间（PT）值。然而，在使用INR进行拔牙时，尚无基于科学的指导方针。对口腔颌面外科医生进行了调查，以确定INR是否是他们用于监测抗凝水平的方法，并确定抗凝患者需要拔牙时遵循的方案。
对北美学术型口腔颌面外科医生进行邮件调查，以确定他们在评估口服抗凝剂患者时选择的实验室检查方法以及拔牙前的方案。
73名受访者中有53名（73%）常规使用INR，但仅21%仅依赖此方法。分别有12%和11%的受访者还使用PT值和PT比值。外科医生进行拔牙时的抗凝水平各不相同。对于使用INR的人来说，范围是1.3至4.0；对于使用PT比值的人来说，可接受的安全范围是1.0至2.0；对于使用PT值的人来说，范围是13至21秒。
尽管医学文献支持使用INR，但许多口腔颌面外科医生仍使用PT来监测口服抗凝治疗。对于可以安全进行拔牙的INR区间尚无共识。该领域需要进行前瞻性研究。
