抗血栓療法施行患者の抜歯における出血管理に関する検討

抄録

We examined hemostatic management for tooth extraction in Japanese patients undergoing antithrom botictherapy.
The subjects consisted of 57 patients aged from 18 to 91 years old. Forty patients received warfarin therapy including 15 receiving additional antiplatelet drugs. The remaining 17 patients received antiplatelet drugs (aspirin, tichlopidine hydrochloride and cilosta zol).In patients receiving warfarin therapy, 19 pa tientswere controlled in International Normalized Ratio (INR)<2.0, 14 in INR 2.0-2.5 and 7 in INR 2.5-3.0.
One-hundred and six teeth were extracted on 65 occasions. All teeth were extracted without reducing the usual antithrombotic therapy, oxidized cellulose was applied and suturing was performed for local hemostasis.
Three of 65 cases of tooth extraction showed postoperative hemorrhage (4.6%); two occurred in patients under warfarin therapy, with INR of 2.15 and 2.49, respectively. The other case was a patient who received both aspirin and tichlopidine hydrochlo ride.In these patients, because gingivitis, alveolar and gingival abscess were observed, postoperative hemorrhage appeared to be caused by local inflamma tionrather than antithrombotic therapy.
These results suggest that sufficient hemostasis can be obtained in most cases of tooth extraction under anticoagulant therapy with warfarin (INR<3.0) and antiplatelet drugs. An appropriate local hemostatic method can obtain hemostasis in case of postopera tivehemorrhage.