Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery
Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery
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DOI：
10.1016/j.joms.2002.12.001
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发表时间：
2003-12-01
影响因子：
1.9
通讯作者：
Amer, MZ
中科院分区：
文献类型：
--
作者：
Al-Belasy, FA;Amer, MZ
目的：我们的目的是评估正丁基-2-氰基丙烯酸酯（Histoacryl； B. Braun, Melsungen, Germany）胶在接受华法林治疗的门诊口腔手术患者的局部止血效果，这些患者的抗凝水平没有改变。材料与方法：30例连续接受华法林治疗的患者随机分为研究组和对照组，10例未接受过抗凝治疗的患者作为阴性对照组。所有患者在拔牙前均测定凝血酶原时间及国际标准化比值（INR）。对照组和阴性对照组采用明胶海绵和多次中断的可吸收缝线进行止血和初步缝合，研究组采用Histoacryl胶和最少中断的可吸收缝线进行止血。术后如出现异常出血，应及时联系口腔外科医生。术后第10天观察无术后出血的患者。收集数据，使用Mantel-Haenzel检验分析年龄和性别分布、拔牙数量、INR水平和需要治疗的出血的统计差异。统计学意义为P < 0.05。结果：研究组患者立即获得局部止血，对照组和阴性对照组仅在10 ~ 20分钟后获得局部止血。在出血并发症方面，阴性对照患者和研究患者均无术后出血需要治疗的病例。对照组5例术后自发性出血需要治疗。这一差异具有统计学意义。患者无伤口感染，愈合过程正常。结论：只要采取有效的局部止血措施，口服抗凝治疗的患者可以在不改变抗凝水平的情况下进行多次拔除。在这方面，组织丙烯胶作为局部黏合剂用于近似伤口边缘，是一种有效且易于应用的口腔手术局部止血剂。(C) 2003年美国口腔颌面外科医师协会。
Purpose: Our goal was to evaluate the local hemostatic effect of n-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) glue in warfarin-treated patients who undergo outpatient oral surgery without a change in their level of anticoagulation.Materials and Methods: Thirty consecutive warfarin-treated patients randomly assigned to study and control groups and 10 patients who had never been on anticoagulant therapy serving as the negative control group were included in this trial. Before multiple teeth extractions, all patients had a prothrombin time and the international normalized ratio (INR) determined. To gain hemostasis and primary closure, gelatin sponge and multiple interrupted resorbable sutures were used in the control and negative control groups, and Histoacryl glue and the minimal number of interrupted resorbable sutures were used in the study group. Postoperatively, patients were to contact the oral surgeon if abnormal bleeding occurred. Patients who did not have postoperative bleeding were seen on the 10th postoperative day. Data were collected, and statistical differences in age and gender distributions, number of teeth extracted, INR levels, and bleeding that required treatment were analyzed with the Mantel-Haenzel test. Statistical significance was defined as a value of P < .05.Results: Local hemostasis was obtained immediately in study patients and only after 10 to 20 minutes in the control and negative control patients. In relation to bleeding complications, there were no cases of postoperative bleeding requiring treatment in both the negative control patients and study patients. In the control patients, 5 cases had postoperative spontaneous bleeding that required treatment. This difference was statistically significant. No patient had wound infection and the healing process appeared to be normal.Conclusion: Multiple extractions can be performed in patients taking oral anticoagulant therapy without a change in their level of anticoagulation provided an efficient local hemostatic measure is instituted. And, in this regard, Histoacryl glue, used as a topical adhesive over approximated wound edges, is an effective and easily applicable local hemostatic for oral surgery in such patients. (C) 2003 American Association of Oral and Maxillofacial Surgeons.