抜歯後出血の要因と対処法に関する臨床的検討

抄録

We conducted a clinical study on patients with post-tooth extraction bleeding who required treatment. A retrospective investigation was performed using the medical records of 71 patients to examine the use of antithrombotic drugs, the presence of underlying conditions necessitating antithrombotic therapy, bleeding sites, hemostatic methods, and the relationship between bleeding and antithrombotic therapy.

The bleeding sites were classified into four areas for both the upper and lower jaws：anterior teeth, premolars, molars, and wisdom teeth. The causes of post-extraction bleeding and the role of antithrombotic therapy were also evaluated for patients treated with surgical splints and patients treated with tamponade. Hemostatic methods were categorized into three grades：Grade 1, where gauze pressure alone was sufficient； Grade 2, where surgical treatment such as suturing was required； and Grade 3, where systemic hemostatic treatment such as intravenous therapy was necessary in addition to surgical treatment.

Of the 71 cases, seven patients were treated with Grade 1 methods and 64 with Grade 2 methods. Across the 87 sites where hemostasis was performed, seven were Grade 1, 80 were Grade 2, and none were Grade 3. Among the Grade 2 cases, seven patients （12 sites） were managed with sutures alone, 43 patients （51 sites） were treated with a combination of sutures and local hemostatic agents, six patients （seven sites） required a surgical splint, and eight patients （10 sites） were managed with tamponade.

This study demonstrates that although post-extraction bleeding is primarily caused by local factors, patients receiving anticoagulants as part of antithrombotic therapy—especially those using warfarin—require additional caution. For these patients, surgical splints and tamponade should be employed from the outset, and postoperative medication adherence should be emphasized.