Dental extractions for patients on oral antiplatelet: a within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte- and platelet-rich fibrin (L-PRF) plugs and suturing alone.
Dental extractions for patients on oral antiplatelet: a within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte- and platelet-rich fibrin (L-PRF) plugs and suturing alone.
复制标题
口服抗血小板药物患者的拔牙：一项体内随机对照试验，比较了止血塞、高级富血小板纤维蛋白 (A-PRF) 塞、白细胞和富血小板纤维蛋白 (L-PRF) 塞以及单独缝合。
DOI：
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复制
发表时间：
2019
影响因子：
2.8
通讯作者：
L. Fortunato
中科院分区：
文献类型：
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作者：
A. Giudice;M. Esposito;F. Bennardo;Ylenia Brancaccio;J. Buti;L. Fortunato
目的
PURPOSE
To compare the outcome of tooth extractions in patients taking oral antithrombotic without reducing their dose. Four different interventions were compared within the same patient: suturing alone (control group), suturing plus a haemostatic plug, suturing plus advanced-platelet-rich fibrin (A-PRF+) plug, and suturing plus leukocyte- and platelet-rich fibrin (L-PRF) plug into the socket.
MATERIALS AND METHODS
Forty patients, taking oral antiplatelet agents, requiring the extraction of at least four non-adjacent teeth were selected for the study. After extractions the sockets were randomly allocated to suturing alone (control group), suturing plus haemostatic plug (HAEM), suturing plus advanced-platelet-rich fibrin (A-PRF+) plug, and suturing plus leukocyte- and platelet-rich fibrin (L-PRF) plug into the socket without reducing the dose of oral antiplatelets according to a split-mouth design. Outcome measures were complications, time to complete each procedure, postoperative bleeding, costs of the materials, patient preference and a wound healing index recorded 1 and 2 weeks postextraction by blinded assessors.
RESULTS
Two weeks after extraction no patient dropped out and no complication was reported. The average time to complete suturing after tooth extractions was: 1.0 ± 0.00 minutes at control sites, 1.5 ± 0.41 at HAEM sites, 2.8 ± 0.61 at A-PRF+ sites, and 2.8 ± 0.56 at L-PRF sites, the difference being statistically significant between each pairwise comparison except A-PRF+ vs L-PRF. Postoperative bleeding 30 minutes after extractions was present at 8, 5, 1 and 2 sites for control, HAEM, A-PRF+ and L-PRF sites, respectively. A-PRF showed statistically significantly less bleeding compared to the control group (odds ratio = 0.1 (95% CI [0.01;0.86]; P < 0.0361). In all cases bleeding was moderate in nature and not severe. One week after extractions the mean wound healing index was 1.05 ± 0.60 for control, 1.18 ± 0.59 for HAEM, 1.00 ± 0.68 for A-PRF+ and 0.95 ± 0.50 for L-PRF sites. No statistically significant difference was detected across groups (P = 0.633). Two weeks after extractions the mean wound healing index was 0.33 ± 0.53 for control, 0.43 ± 0.50 for HAEM, 0.25 ± 0.49 for A-PRF+ and 0.15 ± 0.36 for L-PRF sites. No statistically significant difference across groups was detected (P = 0.255). One week after extractions, nine patients preferred control sites, eight HAEM, ten A-PRF+, four L-PRF and nine had no preference. No statistically significant differences were detected for control sites (P = 0.6779), HAEM (P = 1.0000), A-PRF+ (P = 0.4055) and L-PRF (P = 0.1472). Two weeks after extractions five patients preferred control sites, three HAEM, eight A-PRF+, eight L-PRF and 16 had no preference. No statistically significant differences were detected for control sites (P = 0.8147), HAEM (P = 0.2363), A-PRF+ (P = 0.3488) and L-PRF (P = 0.3488). Costs without counting sutures and blood centrifuges were 0.00, 14.49, 2.44 and 2.44 Euro for control, HAEM, A-PRF+ and L-PRF sites, respectively.
CONCLUSIONS
It may not be necessary to discontinue the use of oral antiplatelets in patients undergoing dental extractions and, when present, the minor statistically significant differences between procedures were not clinically relevant; therefore clinicians can use any of the tested interventions according to their preference, keeping in mind that simple suturing is sufficient and is faster and cheaper, and that A-PRF+ was associated with less postoperative bleeding when compared to suturing alone.