Poređenje efikasnosti različitih metoda lokalne hemostaze kod pacijenata na oralnoj antikoagulantnoj terapiji posle ekstrakcije zuba
Sažetak
Uvod/Cilj. Pacijenti koji duže vremena primaju antikoagulantnu terapiju predstavljaju poseban izazov prilikom invazivnih dentalnih procedura. Cilj rada bio je da se uporede različite metode lokalne hemostaze kod pacijenata na oralnoj antikoagulatnoj terapiji nakon ekstrakcije zuba. Metode. Ukupno 90 pacijenata na oralnoj antikoagulantnoj terapiji sa International Normalized Ratio (INR) vrednostima ≤ 3,0 kojima je bila potrebna ekstrakcija jednog ili dva zuba, bilo je podeljeno u tri grupe, po 30 ispitanika u svakoj grupi, zavisno od primenjenog metoda lokalne hemostaze. Grupu A činili su pacijenti čija je ekstrakciona rana ušivena, a zabeležena prosečna INR vrednost u ovoj grupi iznosila je 2,35 ± 0,37. U grupi B za postizanje lokalne hemostaze u ekstrakcionu ranu su postavljani resorptivni želatinski sunđeri, bez ušivanja. Prosečna INR vrednost u ovoj grupi iznosila je 2,43 ± 0,4. U grupi C (pacijenti sa prosečnom INR vrednošću 2,36 ± 0,34) posle ekstrakcije zuba nisu korišteni ni lokalni hemostatici, niti je rana ušivana. Produženo postekstrakcijsko krvarenje definisano je kao događaj u slučaju da početne mere hemostaze nisu bile dovoljne ili je bila potrebna dodatna oralnohirurška intervencija. Rezultati. Kod 1 (3,3%) pacijenta u grupi A i po 2 (6,7%) pacijenta u grupi B i grupi C javilo se produženo postekstrakcijsko krvarenje. Nije utvrđeno postojanje statistički značajne razlike u učestalosti krvarenja po grupama (χ² = .42; p > 0.05). Svi pacijenti sa produženim krvarenjem bez poteškoća zbrinuti su merama lokalne hemostaze i svi su, izuzev jednog, registrovani u prva dva časa nakon intervencije. Zaključak. Kod pacijenata na oralnoj antikoagulantnoj terapiji moguće je bezbedno izvršiti ekstrakciju zuba bez izmene terapijskog režima uz primenu adekvatnih mera lokalne hemostaze. Kod pacijenata sa INR ≤ 3,0 nakon jednostavnih ekstrakcija zuba kompresija rane gazom u većini slučajeva dovoljna je mera za postizanje lokalne hemostaze.
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