口服新型抗凝药患者牙拔除术后出血情况分析  

Analysis of the bleeding status after dental extraction in patients undergoing direct oral anticoagulants treatment

作　　者：马永清 杨苗苗 贺平 MA Yong-qing;YANG Miao-miao;HE Ping(Department of Oral and Maxillofacial Surgery,Dalian Stomatological Hospital,Dalian 116021,China;不详)

机构地区：[1]大连市口腔医院口腔外科,辽宁大连116021 [2]大连市口腔医院种植科,辽宁大连116021

出　　处：《中国实用口腔科杂志》2020年第11期674-677,共4页Chinese Journal of Practical Stomatology

摘　　要：目的分析口服新型抗凝药患者牙拔除术后出血情况。方法选取2018年1月至2019年8月于大连市口腔医院心电监护门诊行牙拔除术的口服抗凝药患者212例作为研究组,其中口服新型抗凝药直接凝血酶抑制剂达比加群酯患者67例(凝血酶抑制剂组),口服新型抗凝药直接Ⅹa因子抑制剂利伐他班或阿哌沙班患者59例(Ⅹa因子抑制剂组),口服华法林患者86例(华法林组)。选取同期行牙拔除术的未服用抗凝药患者99例作为对照组。观察并记录各组患者牙拔除术后0.5、1、24、72 h的出血情况。结果术后0.5、24 h各组出血发生率总的比较,差异有统计学意义(χ^2值分别为9.79、8.13,P值分别为0.021、0.044)。进一步组间两两比较发现,各研究组出血发生率高于对照组,且华法林组出血发生率高于凝血酶抑制剂组和Ⅹa因子抑制剂组,差异均有统计学意义(均P <0.05),而两新型抗凝药组(凝血酶抑制剂组与Ⅹa因子抑制剂组)比较,差异无统计学意义(P> 0.05)。术后1、72 h各组出血发生率比较,差异均无统计学意义(χ^2值分别为4.06、5.56,P值分别为0.251、0.165)。结论相较于口服华法林患者,口服新型抗凝药患者牙拔除术后出血发生率更低,故口服新型抗凝药患者无需因简单的牙拔除术而调整或中断服用抗凝药。Objective To compare the incidences of bleeding after simple tooth extractions in patients taking direct oral anticoagulants. Methods Totally 212 patients taking direct oral anticoagulants who had undergone dental extractions between January 2018 and August 2019 in our hospital were divided into four groups:67 cases in direct thrombin inhibitor group,59 cases in factor Ⅹa inhibitor group,and 86 cases in warfarin group. Totally 99 patients without taking oral anticoagulants were selected as control group. The patients were evacuated respectively in half an hour,1 hour,24 hours and 72 hours after extraction for bleeding. Results For half an hour and 24 hours after extraction,the incidences of bleeding were totally or partially different(χ^2= 9.79,8.13;P = 0.021,0.044). Patients in experimental groups had a higher incidence of postoperative bleeding than those in control group. Patients in warfarin group had a significantly higher rate of bleeding than other three groups(P < 0.05),but there was no statistical differences between direct thrombin inhibitor group and factor Ⅹa inhibitor group(P > 0.05). Additionally,we found that there was no statistical difference in the incidences of postoerative bleeding after 1 hour or 72 hours among the 4 groups(χ^2= 4.06,5.56;P = 0.251,0.165).Conclusion Patients taking warfarin have higher bleeding incidence compared to patients taking direct oral anticoagulants after tooth extraction. For patients taking direct oral anticoagulants,simple tooth extraction can be safely carried out without altering the anticaogulant regimen.

关 键 词：新型抗凝药 达比加群酯 利伐沙班 阿哌沙班 华法林 牙拔除术 出血 

分 类 号：R78[医药卫生—口腔医学]