Myths of dental surgery in patients receiving anticoagulant therapy
Myths of dental surgery in patients receiving anticoagulant therapy
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DOI：
10.14219/jada.archive.2000.0024
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发表时间：
2000-01-01
影响因子：
3.9
通讯作者：
Wahl, MJ
中科院分区：
文献类型：
--
作者：
Wahl, MJ
背景资料。使用华法林进行持续抗凝治疗是为了预防各种医学并发症，包括血栓栓塞症和中风。当接受持续抗凝治疗的患者被安排进行牙科手术时，必须决定是否继续或中断抗凝治疗。作者回顾了相关文献，重点介绍了接受持续抗凝治疗的患者和在接受牙科手术前停止抗凝治疗的患者的牙科手术情况。在接受持续抗凝治疗的950多名患者中(包括许多抗凝水平远远高于目前推荐的治疗水平的患者)，他们接受了2400多次手术，只有12人(1.3%)需要超过局部措施来控制出血。这些患者中只有3名(0.31%)的抗凝水平低于或低于目前推荐的治疗水平。在526名经历了575次连续抗凝治疗中断的患者中，5名(0.95%)发生了严重的血栓并发症；其中4名患者死亡。抗凝治疗中断的患者发生包括死亡在内的严重血栓并发症的可能性是继续抗凝治疗的患者(且抗凝水平在或低于治疗水平)的出血并发症的三倍。中断牙科手术持续抗凝的治疗水平并不是基于科学事实，而似乎是基于其自身的神话。临床意义。牙科医生应建议接受牙科手术的患者继续进行抗凝治疗。医生应咨询患者的医生，如果有必要，以确定他或她的抗凝水平，然后再进行牙科手术。
Background. Continuous anticoagulant therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous anticoagulant therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the anticoagulant therapy.Methods. The author reviewed the literature, focusing on dental surgery in patients receiving continuous anticoagulant therapy and in patients whose anticoagulant therapy was withdrawn before they underwent dental procedures.Results. Of more than 950 patients receiving continuous anticoagulant therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous anticoagulant therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died.Conclusions. Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology.Clinical Implications. Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.