Hemostatic Management after Tooth Extraction in Patients under Ongoing Antithrombotic Therapy
The purpose of this study was to investigate postoperativebleedingfor tooth extraction in patients maintained on oral antithrombotic therapy. The subjects were 41 patients who came to the Kasaoka Hospital from April 2009 to December 2010, including15 receiving warfarin alone, 7 receiving warfarin wi...
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| Published in | Ronen Shika Igaku Vol. 27; no. 1; pp. 25 - 29 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society of Gerodontology
30.06.2012
一般社団法人 日本老年歯科医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-3866 1884-7323 |
| DOI | 10.11259/jsg.27.25 |
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| Abstract | The purpose of this study was to investigate postoperativebleedingfor tooth extraction in patients maintained on oral antithrombotic therapy. The subjects were 41 patients who came to the Kasaoka Hospital from April 2009 to December 2010, including15 receiving warfarin alone, 7 receiving warfarin with additional antiplatelet drugs, and 19 receivingantiplatelet drugs alone. A total of 157 teeth were extracted on 94 occasions. All teeth were extracted without reducingthe usual antithrombotic therapy, andagelatin sponge was applied and suturing was performed for local hemostasis. Postoperative hemorrhage occurred in only 2 of 94 occasions of tooth extractions; one case was with warfarin alone and the other case was with warfarin and additional antiplatelet drugs. In both cases, local hemostatic methods, biting downongauze for compression and applyingsprint for hemostasis, were successful in 30 minutes when postoperative hemorrhage occured. Serious thromboembolisms includingfatal cases have been previously reported in 1% cases when tooth extraction was enforced with discontinuinganticoagulant therapy. Therefore, tooth extraction under the condition of continuing oral antithrombotic therapy was recommended by the guideline of the Japanese Circulation Society in 2004. However, accordingto a survey in 2007, many physicians and dentists still reduced or stopped temporarily anticoagulant or antiplatelet drugs in spite of the guideline. We considered it important to sensitize both medicine and dentistry professionals to the importance of appropriate dental treatment for elderly people with antithrombotic therapy, whose numbers are increasingin Japan. |
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| AbstractList | The purpose of this study was to investigate postoperativebleedingfor tooth extraction in patients maintained on oral antithrombotic therapy. The subjects were 41 patients who came to the Kasaoka Hospital from April 2009 to December 2010, including15 receiving warfarin alone, 7 receiving warfarin with additional antiplatelet drugs, and 19 receivingantiplatelet drugs alone. A total of 157 teeth were extracted on 94 occasions. All teeth were extracted without reducingthe usual antithrombotic therapy, andagelatin sponge was applied and suturing was performed for local hemostasis. Postoperative hemorrhage occurred in only 2 of 94 occasions of tooth extractions; one case was with warfarin alone and the other case was with warfarin and additional antiplatelet drugs. In both cases, local hemostatic methods, biting downongauze for compression and applyingsprint for hemostasis, were successful in 30 minutes when postoperative hemorrhage occured. Serious thromboembolisms includingfatal cases have been previously reported in 1% cases when tooth extraction was enforced with discontinuinganticoagulant therapy. Therefore, tooth extraction under the condition of continuing oral antithrombotic therapy was recommended by the guideline of the Japanese Circulation Society in 2004. However, accordingto a survey in 2007, many physicians and dentists still reduced or stopped temporarily anticoagulant or antiplatelet drugs in spite of the guideline. We considered it important to sensitize both medicine and dentistry professionals to the importance of appropriate dental treatment for elderly people with antithrombotic therapy, whose numbers are increasingin Japan. The purpose of this study was to investigate postoperativebleedingfor tooth extraction in patients maintained on oral antithrombotic therapy. The subjects were 41 patients who came to the Kasaoka Hospital from April 2009 to December 2010, including15 receiving warfarin alone, 7 receiving warfarin with additional antiplatelet drugs, and 19 receivingantiplatelet drugs alone. A total of 157 teeth were extracted on 94 occasions. All teeth were extracted without reducingthe usual antithrombotic therapy, andagelatin sponge was applied and suturing was performed for local hemostasis. Postoperative hemorrhage occurred in only 2 of 94 occasions of tooth extractions; one case was with warfarin alone and the other case was with warfarin and additional antiplatelet drugs. In both cases, local hemostatic methods, biting downongauze for compression and applyingsprint for hemostasis, were successful in 30 minutes when postoperative hemorrhage occured. Serious thromboembolisms includingfatal cases have been previously reported in 1% cases when tooth extraction was enforced with discontinuinganticoagulant therapy. Therefore, tooth extraction under the condition of continuing oral antithrombotic therapy was recommended by the guideline of the Japanese Circulation Society in 2004. However, accordingto a survey in 2007, many physicians and dentists still reduced or stopped temporarily anticoagulant or antiplatelet drugs in spite of the guideline. We considered it important to sensitize both medicine and dentistry professionals to the importance of appropriate dental treatment for elderly people with antithrombotic therapy, whose numbers are increasingin Japan. 本研究では，抗血栓療法患者に対して抗血栓薬内服継続下で抜歯を行った際の止血状態を調査した。対象は平成 21 年 4 月から平成 22 年 12 月までに笠岡第一病院歯科を受診した患者 41 名（抗凝固療法単独 15 名，抗凝固療法と抗血小板療法の併用 7 名，抗血小板療法単独19 名）とし，合計 94 回，157 本の抜歯を行い，後出血の件数を調査した。抜歯直前に測定した PT-INR 値は 1.0〜1.49が7件，1.5〜1.99 が 18 件，2.0〜2.49が8件，2.5〜2.99 が 5 件であった。3.0 以上は認めなかった。すべての抜歯において内服の減量および中止は行わず，抜歯窩へのゼラチンスポンジの挿入，縫合および圧迫止血を行った。全抜歯 94 件のうち，抗凝固療法単独症例で 1 件，抗凝固療法と抗血小板療法の併用症例で 1 件の計 2 件において後出血を認めた。抗血小板療法単独症例での後出血は認めなかった。いずれも圧迫止血および止血用シーネの使用により 30 分程度で止血可能であった。抗血栓薬の中止により，死亡例を含む血栓塞栓症のリスクが高まることが示されており，平成 22 年に歯科では初めてとなる「抗血栓療法患者の抜歯に関するガイドライン」が作成され，血栓薬内服継続下での抜歯が推奨された。本研究の抜歯手技はそれに準じているが，抜歯後出血の割合はごくわずかで，起こった場合でも容易にかつ短時間で止血可能であったことから，ガイドラインにのっとり，抗血栓薬内服継続下での抜歯が可能であることが示唆された。 |
| Author | Toyota, Masahito Minagi, Shogo |
| Author_FL | 豊田 眞仁 皆木 省吾 |
| Author_FL_xml | – sequence: 1 fullname: 豊田 眞仁 – sequence: 2 fullname: 皆木 省吾 |
| Author_xml | – sequence: 1 fullname: Minagi, Shogo organization: Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University – sequence: 1 fullname: Toyota, Masahito organization: Department of Dentistry, Kasaoka Daiichi Hospital |
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| References | 8）Aframian, D. J. , Lalla, R. V and Peterson, D. E. ：Management of dental patients takingcommon hemostasis-alteringmedications, Oral Surg. Oral Med. Pathol. Oral Radiol. Endod. , 103(Suppl 1)：S45.e1〜11, 2007. 3）Maulaz, A. B. , Bezerra, D. C. , Michel, P. and Bogousslavsky, J. ：Effect of discontinuingaspirin therapy on the risk of brain ischemic stroke, Arch. Neurol. , 62：1217〜1220, 2005. 1）Medical Tribune, 41(10), p. 74, メディカルトリビューン，東京，2008 7）Evans, I. L. , Sayera, M. S. , Gibbons, A. J. , Price, G. ,Snooks, H. and Sugar, A. W. ：Can warfarin be continued duringdental extraction? Results of randomized controlled trial, Br. J. Oral Mxillofac. Surg. , 40：248〜252, 2002. 2）Wahl, M. J. ：Dental surgery in anticoagulated patients, Arch. Intern. Med., 36：107〜111, 1998. 4）2002〜2003 年度合同研究班報告（日本循環器学会，日本心臓病学会，日本血栓止血学会，日本臨床血液学会，日本神経学会，日本脳卒中学会，日本冠疾患学会，日本心血管インターベンション学会，日本人工臓器学会，日本脈管学会，日本胸部外科学会，日本心血管外科学会，日本小児循環器学会）：循環器疾患における抗凝固・抗血小板療法に関するガイドライン，Circ. J. , 68(SupplⅣ)：1153〜1219, 2004. 11）Morimoto, Y. , Niwa, H. and Minematsu, K. ：Hemostatic management of tooth extractions in patients on oral antithrombotic therapy, J. Oral Maxillofac. Surg. , 66：51〜57, 2008. 6）Devani, P. , Lavery K. M. and Howell, C. J. T. ：Dental extractuins in patients on warfarin―Is alternation of anticoagulant regime necessary? Br. J. Oral Maxillofac. Surg. , 36：107〜111, 1998. 5）矢坂 正弘：観血的な医学的処置時の抗血栓療法の管理に関する研究―全国アンケート調査結果，Brain and Nerve. , 59：871〜876, 2007. 9）2006〜2007 年度合同研究班報告（日本循環器学会，日本心臓病学会，日本心電学会，日本不整脈学会）．心房細動治療（薬物）ガイドライン（2008 年改訂版），Circ. J. , 72 (SupplⅣ)：1581〜1638, 2008. 10）日本有病者歯科医療学会，日本口腔外科学会，日本老年歯科学会：「抗血栓療法患者の抜歯」に関するガイドライン，第一版，学術社，東京，2010 藤盛真樹，西村泰一，吉田将亜，竹川政範，池畑正宏，嶋津真史，鳥谷部純行，大坪誠治，末次 博，佐藤泰祥，松田光悦：抗血栓療法施行患者における抜歯後出血に関する臨床的検討，日口腔科会誌，59：113〜122，2010. |
| References_xml | – reference: 7）Evans, I. L. , Sayera, M. S. , Gibbons, A. J. , Price, G. ,Snooks, H. and Sugar, A. W. ：Can warfarin be continued duringdental extraction? Results of randomized controlled trial, Br. J. Oral Mxillofac. Surg. , 40：248〜252, 2002. – reference: 5）矢坂 正弘：観血的な医学的処置時の抗血栓療法の管理に関する研究―全国アンケート調査結果，Brain and Nerve. , 59：871〜876, 2007. – reference: 9）2006〜2007 年度合同研究班報告（日本循環器学会，日本心臓病学会，日本心電学会，日本不整脈学会）．心房細動治療（薬物）ガイドライン（2008 年改訂版），Circ. J. , 72 (SupplⅣ)：1581〜1638, 2008. – reference: 11）Morimoto, Y. , Niwa, H. and Minematsu, K. ：Hemostatic management of tooth extractions in patients on oral antithrombotic therapy, J. Oral Maxillofac. Surg. , 66：51〜57, 2008. – reference: 1）Medical Tribune, 41(10), p. 74, メディカルトリビューン，東京，2008． – reference: 8）Aframian, D. J. , Lalla, R. V and Peterson, D. E. ：Management of dental patients takingcommon hemostasis-alteringmedications, Oral Surg. Oral Med. Pathol. Oral Radiol. Endod. , 103(Suppl 1)：S45.e1〜11, 2007. – reference: 6）Devani, P. , Lavery K. M. and Howell, C. J. T. ：Dental extractuins in patients on warfarin―Is alternation of anticoagulant regime necessary? Br. J. Oral Maxillofac. Surg. , 36：107〜111, 1998. – reference: 10）日本有病者歯科医療学会，日本口腔外科学会，日本老年歯科学会：「抗血栓療法患者の抜歯」に関するガイドライン，第一版，学術社，東京，2010． – reference: 3）Maulaz, A. B. , Bezerra, D. C. , Michel, P. and Bogousslavsky, J. ：Effect of discontinuingaspirin therapy on the risk of brain ischemic stroke, Arch. Neurol. , 62：1217〜1220, 2005. – reference: 藤盛真樹，西村泰一，吉田将亜，竹川政範，池畑正宏，嶋津真史，鳥谷部純行，大坪誠治，末次 博，佐藤泰祥，松田光悦：抗血栓療法施行患者における抜歯後出血に関する臨床的検討，日口腔科会誌，59：113〜122，2010. – reference: 2）Wahl, M. J. ：Dental surgery in anticoagulated patients, Arch. Intern. Med., 36：107〜111, 1998. – reference: 4）2002〜2003 年度合同研究班報告（日本循環器学会，日本心臓病学会，日本血栓止血学会，日本臨床血液学会，日本神経学会，日本脳卒中学会，日本冠疾患学会，日本心血管インターベンション学会，日本人工臓器学会，日本脈管学会，日本胸部外科学会，日本心血管外科学会，日本小児循環器学会）：循環器疾患における抗凝固・抗血小板療法に関するガイドライン，Circ. J. , 68(SupplⅣ)：1153〜1219, 2004. |
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| SubjectTerms | antithrombotic therapy postoperative hemorrhage PT-INR tooth extraction 後出血 抗血栓療法 抜歯 |
| Title | Hemostatic Management after Tooth Extraction in Patients under Ongoing Antithrombotic Therapy |
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