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Register a new userDental Extraction in Patients Receiving Warfarine Therapy ( Prospective Descriptive Study)
قلع الأسنان عند المرضى الخاضعين للعلاج بالوارفارين (دراسة مستقبلية وصفية )
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منذر أسعد( باحث )
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دراسة مستقبلية وصفية تمت على 32 مريضاً من مراجعي قسم جراحة الفم و الفكين- جامعة تشرين ممن لديهم أمراض قلبية و وعائية مختلفة و الخاضعين للعلاج بمميعات الدم(الوارفارين)حيث هدفت الدراسة إلى تحديد قيم INR التي تجعل بالإمكان إجراء قلوع الأسنان لدى هؤلاء المرضى دون إيقاف أو تعديل في جرعات مميعات الدم و بدون تعريض المرضى لخطورة العمل الجراحي و لإتمام هذه الدراسة قمنا باستخدام المتغيرات التالية: نوع العلاج الجراحي, طبيعة الإصابة القلبية, جرعة مميعات الدم, قيم INR, الطرق المستخدمة في الإرقاء الموضعي. خضع 56.25 % من المرضى لقلوع أسنان مفردة, 25% قلوع متعددة, 18.75% قلوع جراحية و كان القيم الوسطى لل INR 2.38 بتفاوت طبيعي قدره 0.07 و بمعدل التشتت 0.27 و هذا يعني أنه ذو دلالة ضعيفة و بفضل الطرق المستخدمة في الإرقاء الموضعي لم يحدث أي اختلاط نزفي ما بعد العمل الجراحي لذلك بدا لنا بالنتيجة بأن خطورة حدوث حوادث صمات خثرية ناجمة عن وقف مميعات الدم هي أكثر خطورة على حياة المريض من احتمال النزوف في حال عدم إيقافها.
The study is prospective and descriptive it take place in the department of oral surgery in Tishreen university it concerned 32 patients presented a cardiovascular pathology having required an warfarine therapy and also need an act of oral surgery the objective of this study was to determine the INR value making possible to carry out an act of oral surgery without haemorrhagic risk we exploited the following parameters: identification of the patient, oral state, type of oral surgery, type of cardiopathy, AVK posology, INR value, means haemostasis. 56.25% of our patients had undergone a single extraction, 25% had beneficed multiple extractions and 18.75% had profited from surgical extraction the average value of the INR was 2.38 with an variance of 0.07 and an ecart type of 0.27. In favour of the haemostat means no haemorrhagic complication post operational was revealed it is allowed that the risk of thromboembolic accident by stoping the treatment is much more prejudicial than hemorrhagic risk for the patent.
References used
TROULIS, M. J; HEAD, T. W; LECLERC, J. R. What Is The INR?. Can Dent J, Vol. 62, No.5, 1996, 428-430
HARRISON. Harrison`s Principles of Internal Medicine. 12th .ed., Wilson, J.D., et al, Inc New York, 1991, 348-351
ANDREWS, T. C; PETERSON, D. W; DOEPPENSCHMIDT, D; FOSTER, J. S; LUCCA, M. J; DEERING, J. A; LAVEAU, P. J. Complication of Warfarine Therapy Monitored By The International Normalized Ratio Versus The Prothrombine Time Ratio. Clin Cardio, No.18,1995, 80-82
WAHL, M. J. Dental Surgery in Anticoagulated patients. Arch. Intern. Med, Vol. 158, No. 15, 1998,1610-1616
DESCROZAILLES, C. H; DROUILLAT, J. P.Le Risque Hemorragiaue Chez Les Cardiaques. Actual Odonto-stomatol, No.32, 1978, 245-282
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