目的:探讨抗凝治疗老年患者拔牙术后出血的影响因素。
方法:这项回顾性研究包括年龄≥65岁接受以下抗凝剂之一的患者:阿哌沙班,edoxaban,利伐沙班,还有华法林.包括在2016年8月1日至2020年11月30日期间在东京医学和牙科大学医院的老年牙科诊所进行一到多次拔牙的患者。结果变量为术后出血发生。以以下十个因素为解释变量进行Logistic回归分析:年龄,性别,提取期间的最大收缩压,局部麻醉类型,垂直切口,截骨,使用外科夹板,射线照片上拔出牙齿的中远侧宽度,使用抗血小板药物,和需要药物治疗的糖尿病病史。
结果:在395名参与者中(平均年龄,82.3±6.5年)纳入本研究,75例患者拔牙后发生术后出血。Logistic回归分析显示垂直切口的比值比(18.400,p<0.001),截骨(3.630,p=0.00558),手术夹板的使用(1.860,p=0.0395),并且在X线片上拔牙的中远侧宽度(1.060,p=0.0261)具有统计学意义。
结论:对于接受抗凝剂治疗的老年患者,垂直切口患者更容易发生术后出血,截骨,和后牙或多牙拔除。
结论:对于垂直切口患者,牙医应考虑缝合和辅助止血程序,截骨,在接受抗凝治疗的同时进行多次拔牙,以最大程度地降低术后出血的风险。
OBJECTIVE: To investigate factors influencing postoperative bleeding occurrence after dental extraction in older patients receiving anticoagulation therapy.
METHODS: This retrospective study included patients aged ≥ 65 years receiving one of the following anticoagulants: apixaban, edoxaban, rivaroxaban, and warfarin. Patients who underwent one to multiple tooth extractions in the geriatric dentistry clinic at Tokyo Medical and Dental University Hospital between August 1, 2016, and November 30, 2020, were included. The outcome variable was postoperative bleeding occurrence. Logistic regression analysis was performed with the following ten factors as explanatory variables: age, sex, maximum systolic blood pressure during the extraction, type of local anesthesia, vertical incision, osteotomy, usage of surgical splints, the mesiodistal width of the extracted tooth on a radiograph, use of antiplatelet agents, and history of diabetes requiring medication.
RESULTS: Among 395 participants (mean age, 82.3 ± 6.5 years) included in this study, 75 patients experienced postoperative bleeding after tooth extraction. Logistic regression analysis revealed that the odds ratios for the vertical incision (18.400, p < 0.001), osteotomy (3.630, p = 0.00558), usage of surgical splints (1.860, p = 0.0395), and the mesiodistal width of the extracted tooth on a radiograph (1.060, p = 0.0261) were statistically significant.
CONCLUSIONS: For dental extraction in older patients receiving anticoagulants, postoperative bleeding is more likely to occur in patients with vertical incision, osteotomy, and posterior or multiple tooth extractions.
CONCLUSIONS: Dentists should consider suturing and adjunctive hemostatic procedures for patients undergoing vertical incision, osteotomy, and multiple tooth extractions while receiving anticoagulation therapy to minimize the risk of postoperative bleeding.