摘要：

目的： 比较长期口服抗栓药物患者在拔牙围手术期服用抗栓药物的不同用药和桥接方案。方法： 共有97例患者纳入研究，按照口服抗栓药物的种类，分为阿司匹林组（n=50）、双抗组（阿司匹林+氯吡格雷或替格瑞洛）（n=26）及华法林组（n=21）。阿司匹林组患者围手术期正常使用阿司匹林；双抗组患者围手术期单用阿司匹林，术前停用氯吡格雷或替格瑞洛2~3 d；华法林组患者围手术期停用华法林，改为低分子肝素每次0.4 mL皮下注射2 d（每12 h 1次）。所有患者均拔除患牙，观察有无心脑血管事件的发生，术中监测血压，术后用纱布压迫30 min、1 h、2 h后的观察手术创面出血情况。结果： 97例患者在术中、术后均未出现不良心脑血管事件，2 h后所有患者拔牙创均无明显出血。拔牙数目越多，术后出血时间越长（P<0.05）。结论： 抗栓药物患者采用上述用药和桥接方案拔牙是安全有效且可行的。

关键词: 抗栓药物, 拔牙, 围手术期, 出血时间

Abstract:

Objective: To compare the different medication and the bridging plans of antithrombotic drugs in patients using long-term oral administration during the perioperative period of tooth extraction. Methods: According to the type of antithrombotic drugs, a total of 97 patients were included into the study and divided into the aspirin group(n=50), the two antiplatelets group(aspirin combined with clopidogrel or ticagrelor, n=26), and the warfarin group(n=21). In the aspirin group, aspirin was used normally during the perioperative period. Patients in the two antiplatelets group were given aspirin alone during the perioperative period, and clopidogrel or ticagrelor was stopped for 2-3 days before the operation. In the warfarin group, warfarin was discontinued during the perioperative period and changed to subcutaneous injection of low molecular weight heparin 0.4 mL for 2 days (once every 12 hours). All teeth were minimally invasively extracted in patients to observe the occurrence of cardiovascular and cerebrovascular events, intraoperative blood pressure, and postoperative wound bleeding after gauze compression for 30 minutes, 1 hour, and 2 hours. Results: None of the 97 patients had cardio- vascular and cerebrovascular events during and after the operation. After 2 hours, all patients had no obvious bleeding from the adverse extraction wounds. The more the number of extractions, the longer the bleeding time after surgery(P<0.05). Conclusion: It is safe, effective and feasible for patients with antithrombotic drugs to use all these three medication and bridging plans in the course of exodontia.

Key words: antithrombotic drugs, tooth extraction, perioperative period, bleeding time

中图分类号: 

• R782