Management of antithrombotic therapy in patients undergoing dental procedures.

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-10-10 DOI:10.1016/j.jtha.2024.09.022
James Curtis, Daniel P Henderson, Mehrdad Zarghami, Sina Rashedi, Behnood Bikdeli
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Abstract

A growing number of patients receiving antithrombotic therapy require dental procedures. Dental interventions in these patients can be challenging, as the risk of bleeding from the continuation of antithrombotic therapy needs to be weighed against the thromboembolic risk associated with drug interruption or de-escalation. Most minor dental procedures, including simple dental cleaning and filling, pose minimal bleeding risk, and antiplatelet or anticoagulation therapy can be continued without interruption. Local hemostatic measures, such as tranexamic mouthwash, can be used, as needed, to reduce bleeding events following these interventions. Managing antithrombotic therapy during more invasive dental interventions and oral surgeries with a higher risk of perioperative bleeding necessitates the consideration of specific factors influencing the bleeding risk and thromboembolism. In patients receiving antithrombotic therapy for primary prevention, temporary interruption is reasonable. In others, the decisions may be more complex and more nuanced. In this article, we review the current evidence for managing patients receiving oral antiplatelet or anticoagulant drugs scheduled for various dental procedures and present a practical approach for the periprocedural management of antithrombotic treatments.

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牙科手术患者的抗血栓治疗管理。
越来越多接受抗血栓治疗的患者需要进行牙科手术。对这些患者进行牙科干预具有挑战性,因为需要权衡继续抗血栓治疗的出血风险和药物中断或降级带来的血栓栓塞风险。大多数牙科小手术,包括简单的洗牙和补牙,出血风险都很小,因此可以继续进行抗血小板或抗凝治疗,无需中断。可根据需要使用氨甲环酸漱口水等局部止血措施,以减少这些干预措施后的出血事件。在进行侵入性较强的牙科介入治疗和围手术期出血风险较高的口腔手术时,管理抗血栓治疗需要考虑影响出血风险和血栓栓塞的特定因素。对于为初级预防而接受抗血栓治疗的患者,暂时中断治疗是合理的。而对于其他患者,决定可能会更加复杂和细致。在这篇文章中,我们回顾了目前管理接受口服抗血小板或抗凝药物治疗的牙科手术患者的证据,并提出了抗血栓治疗围手术期管理的实用方法。
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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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