口服抗栓药物患者门诊拔牙围手术期管理的专家共识

doi:10.7518/hxkq.2022.03.002

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (3): 255-263.doi: 10.7518/hxkq.2022.03.002

口服抗栓药物患者门诊拔牙围手术期管理的专家共识

潘剑¹(), 薛洋², 赵吉宏³, 周青⁴, 邹多宏⁵, 陈松龄⁶, 韩冰⁷, 崔念晖⁸, 刘显¹, 王了¹, 胡开进²()

^1.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院口腔外科，成都 610041
^2.军事口腔医学国家重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔疾病临床医学研究中心，第四军医大学口腔医院颌面外科，西安 710032
^3.武汉大学口腔医院口腔外科，口腔生物医学教育部重点实验室，武汉 430079
^4.中国医科大学口腔医学院·附属口腔医院口腔颌面外科，辽宁省口腔疾病重点实验室，沈阳 110001
^5.上海交通大学医学院附属第九人民医院口腔外科，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011
^6.中山大学附属第一医院口腔颌面外科，广州 510080
^7.吉林大学口腔医院口腔颌面外科，长春 130021
^8.北京大学口腔医学院?口腔医院口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字化医疗技术和材料国家工程实验室，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081

收稿日期:2022-01-29 修回日期:2022-04-15 出版日期:2022-06-01 发布日期:2022-06-01
通讯作者: 胡开进 E-mail:jianpancn@163.com;hukaijin2015@126.com
作者简介:潘剑，教授，博士，E-mail：jianpancn@163.com|潘剑，教授，博士，E-mail：jianpancn@163.com ·专家简介·潘剑，男，医学博士，教授，博士研究生导师。四川大学华西口腔医院口腔外科主任。国际牙医师学院院士，中华口腔医学会牙及牙槽外科专业委员会副主任委员，中华口腔医学会口腔颌面外科专业委员会委员，四川省口腔医学会牙及牙槽外科专业委员会主任委员，四川省口腔医学会口腔颌面外科专业委员会副主任委员，四川省医学会口腔专委会委员，四川省抗癌协会头颈肿瘤专业委员会委员。四川省卫生健康委员会学术和技术带头人，临床技能名师。担任《华西口腔医学杂志》和《国际口腔医学杂志》常务编委，《中国口腔颌面外科学杂志》编委。主持国家自然基金和省部级基金13 项，发表学术论文90 余篇，参编专著16 部。|胡开进，教授，博士，E-mail：hukaijin2015@126.com ·专家简介·胡开进，教授，主任医师，博士研究生导师，国际牙医师学院院士，中华口腔医学会牙及牙槽外科专业委员会主任委员，中华口腔医学会口腔颌面外科专业委员会副主任委员，陕西省口腔医学会第二届口腔颌面外科专业委员会主任委员，教育部高等学校口腔医学类专业教学指导委员会委员，国家自然科学基金及国家科技奖评审专家，国家精品课程主讲教授；研究生统编教材《牙及牙槽外科学》及本科统编教材《口腔颌面外科学配套光盘》主编，住院医师规范化培训教材《口腔颌面外科分册》编委，《中国口腔颌面外科杂志》等8 种杂志编委。发表教学和科研论文270 余篇，其中SCI 收录50 余篇，出版专著38 部，其中主编及主译专著19 部，获国家、军队、省部级研究课题16 项，获国家、军队、省部级教学及科研奖励19 项，获国家专利16 项。
基金资助:
四川省干部保健科研课题(川干研2019-901);四川大学华西口腔医院探索与研发项目(LCYJ2019-1)

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

摘要/Abstract

摘要：

血栓栓塞性疾病包括静脉血栓栓塞性疾病和动脉血栓栓塞性疾病，已成为导致全球人口死亡的第一因素，这类患者需要服用抗栓药物对血栓形成进行防治，但在接受外科手术时其出血风险随之增加。拔牙手术是口腔外科门诊最常见的手术，尽管目前普遍认为口服抗栓药物的患者行拔牙手术时无需停药，但这类患者的围手术期管理依旧困惑着大部分口腔外科医师，一些潜在的出血危险因素也需要进一步深入研究。为了提高口腔外科医师对口服抗栓药物拔牙患者的围手术期管理能力，最大程度保障患者健康，相关专家起草本共识，从术前出血风险评估、术中操作规范和术后护理等方面总结相关临床经验，以期为广大同行提供参考。

关键词: 口服抗栓药物, 拔牙术, 围手术期管理, 专家共识

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

中图分类号:

R 782.11

潘剑, 薛洋, 赵吉宏, 周青, 邹多宏, 陈松龄, 韩冰, 崔念晖, 刘显, 王了, 胡开进. 口服抗栓药物患者门诊拔牙围手术期管理的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 255-263.

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.

图/表 3

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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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口服抗栓药物患者门诊拔牙围手术期管理的专家共识

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

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