Experts’ consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment

doi:10.7518/hxkq.2022.03.002

West China Journal of Stomatology ›› 2022, Vol. 40 ›› Issue (3): 255-263.doi: 10.7518/hxkq.2022.03.002

Experts’ consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment

Pan Jian¹(), Xue Yang², Zhao Jihong³, Zhou Qing⁴, Zou Duohong⁵, Chen Songling⁶, Han Bing⁷, Cui Nianhui⁸, Liu Xian¹, Wang Liao¹, Hu Kaijin²()

^1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases & Dept. of Oral Surgery, School of Stomatology, Fourth Military Medical University, Xi’an 710032, China
^3.Dept. of Oral Surgery, Hospital of Stomatology, Wuhan University, Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan 430079, China
^4.Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110001, China
^5.Dept. of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
^6.Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
^7.Dept. of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun 130021, China
^8.Dept. of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & National Health Commission Research Center of Engineering and Technology for Computerized Dentistry & National Medical Products Administration Key Laboratory for Dental Materials, Beijing 100081, China

Received:2022-01-29 Revised:2022-04-15 Online:2022-06-01 Published:2022-06-01
Contact: Hu Kaijin E-mail:jianpancn@163.com;hukaijin2015@126.com
Supported by:
Sichuan Cadres Health Care Project(2019-901);Research and Develop Program, West China Hospital of Stomatology, Sichuan University(LCYJ2019-1);Correspondence: Hu Kaijin, hukaijin2015@126.com

Abstract

Abstract:

Thromboembolic diseases, which comprise venous thromboembolic diseases and arterial thromboembolic diseases, have become the number one cause of death worldwide. To prevent or treat thrombosis, patients with thromboembolic diseases need to take antithrombotic drugs, which would increase the risk of bleeding during and after surgery. Tooth extraction is the most common operation in oral and maxillofacial surgery clinics. Although patients given oral antithrombotic drugs do not need to undergo drug withdrawal, the perioperative management of such patients remains confusing to most clinicians. Moreover, the potential risk factors for bleeding warrant further study. To improve the clinicians’ knowledge of perioperative management for patients subjected to tooth extractions with oral antithrombotic drugs, experts have drafted this consensus focusing on preoperative bleeding risk assessment, intraoperative operating norms, and postoperative care to summarize the points needing attention.

Key words: antithrombotic drugs, tooth extraction, perioperative management, experts’ consensus

CLC Number:

R 782.11

Pan Jian, Xue Yang, Zhao Jihong, Zhou Qing, Zou Duohong, Chen Songling, Han Bing, Cui Nianhui, Liu Xian, Wang Liao, Hu Kaijin. Experts’ consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment[J]. West China Journal of Stomatology, 2022, 40(3): 255-263.

Figures/Tables 3

References 48

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疾病	INR目标值
肺血栓栓塞症抗凝治疗	2.0~3.0
深静脉血栓形成	2.0~3.0；高龄患者1.8~2.5
伴有房颤的缺血性脑卒中和短暂性脑缺血预防血栓再次发生	2.0~3.0
瓣膜病房颤	依据瓣膜部位和种类
非瓣膜病房颤	2~3
风湿性瓣膜病	目标2.5，范围2.0~3.0
瓣膜置换术	1.5~2.5

药物	用法	半衰期/h
达比加群酯	每天2次	12~17
阿哌沙班	每天2次	12~18
利伐沙班	每天1次	5~13

药物	术前不停药		手术当天		术后按常规服药
药物	上午	下午	上午	下午	上午	下午
达比加群酯	√	√	★	√	√	√
阿哌沙班	√	√	★	√	√	√
利伐沙班（早上服）	√	-	★√	-	√	-
利伐沙班（下午服）	-	√	★	√	-	√

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Experts’ consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment

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