今回は
抗凝固剤の服用患者の抜歯後の出血について
休薬・縫合の影響を調べた文献です。
サウジアラビアの病院歯科にて
抜歯を予定している抗凝固剤服用患者214名に対し
縫合あり・なし、休薬あり・なし
の組み合わせで4郡に分けて
抜歯後の後出血と創傷治癒について評価しています。
To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions.
Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7).
Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls.
Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.
結果は
術後出血と治癒には群間に有意差は無かった。
また、縫合した方が術後出血が多い傾向があった。
結論として
INR＜3.0ならば局所の止血が出来ていれば休薬の必要はなく
縫合の必要性は軟組織の損傷程度に依存する
とのことです。
引用文献
Al-Mubarak S1, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, Al-Suwyed A, Ciancio S.
Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy.
Br Dent J. 2007 Oct 13;203(7):E15; discussion 410-1. Epub 2007 Aug 10.