Abstract: Objective: To investigate the clinical availability and security with low-molecular-weight heparin as bridging therapy in patients with long-term oral anticoagulants during dental extraction. Methods: 163 patients discontinued warfarin (87cases) or antiplatelet agents（76 cases） and used low-molecular-weight heparin as bridging therapy. The extraction procedure would proceed after the INR in patients on anticoagulants agents was <2.0, and discontinued antiplatelet agents for 5 days, provided the low-molecular-weight heparin was stopped twelve hours before surgery. The evaluation of the risks of bleeding or thromboembolism was included. Results: There was no thromboembolic event in the perioperative period. 4 of 87 patients on oral warfarin and 1 of 76 patients on oral antiplatelet, occurred bleeding complications after 24 hours of surgery. Low risk of bleeding was showed in the study(5/163). Conclusion: It reveals that bridging therapy with low-molecular-weight heparin in patients with long-term oral warfarin or antiplatelet is safe  and effective in the perioperative period of dental extraction.

Key words: warfarin, antiplatelet agents, dental extraction, thromboembolism, bleeding

摘要： 目的：探讨长期使用抗凝药物的患者，拔牙围手术期使用低分子肝素钠替代抗凝的安全有效性。方法：163例长期使用华法林或抗血小板药物且需拔牙治疗的患者，入院后即停用抗凝药物，围手术期使用低分子肝素钠替代抗凝治疗，华法林组患者INR（国际标准化比值）<2.0，及抗血小板药物组患者，均停用原药物5 d后拔牙（术前12 h停用低分子肝素钠），观察手术24 h后出血情况，分析其安全性、有效性。结果：163例患者围手术期均未出现血栓栓塞、心梗、脑梗等心脑血管并发症。口服华法林患者87例，手术后24 h出血4例；口服抗血小板药物患者76例，手术后24 h出血1例。出血风险低（5/163）。结论：长期使用华法林或抗血小板药物患者，围手术期使用低分子肝素钠替代抗凝的处理方案是安全有效的。

关键词: 华法林；  , 抗血小板药物；  , 拔牙术；  , 血栓栓塞；  , 出血

CLC Number: 

• R782.11