ความเสี่ยงต่อภาวะเลือดออกไม่หยุดจากหัตถการผ่าตัดในช่องปาก ของผู้ป่วยที่มีภาวะเรื้อรัง และการใช้ยาต้านเกล็ดเลือด การศึกษา ตามบริบทการให้บริการของโรงพยาบาลชุมชนแห่งหนึ่งในประเทศไทย

บทคัดย่อ

Objective: To measure risk of immediate and late-onset bleeding complication after oral surgical procedures in patients with chronic conditions and continued antiplatelet therapy compared to other patients without the antiplatelet therapy.

Methods: This study adopted retrospective cohort data collection approach which analyzed 2,723 Thai adult dental patients–aged 30 years old and over–undergoing oral surgical treatments from October 2011 to September 2015 at Phutthamonthon Hospital. Based on past record of medication and history taking on dental visit, patients were categorized as index group receiving continued low-dose aspirin (≤162 mg/day) and referent group without the antiplatelet therapy. Immediate and late-onset bleeding complication was an outcome. Measurable confounders in this clinical context included age, sex, numbers of teeth extracted, surgical procedures, dental arches (maxilla, mandible), positions of teeth, operators, and major diagnoses of underlying chronic diseases. All data were recorded according to time of the first visit for oral surgical service of each patient within the specified data collection period. To measure risk of uncontrolled bleeding attributed to existing chronic conditions and antiplatelet
therapy, risk ratio was estimated by using generalized linear model for risk ratio regression.

Results: Cumulative incidences of bleeding complication were not significantly different between the two groups (index 2.4%, reference 1.7%, p=0.437). After adjusting for potential confounders, estimated risk of uncontrolled bleeding attributed to underlying chronic conditions and antiplatelet therapy of patients in the index was higher than the risk among those in the reference, though not statistically significant (RR=2.3, 95% CI=0.8 to 6.4, p=0.113).

Conclusion: Higher risk of bleeding was identified among patients with underlying chronic conditions and continued antiplatelet therapy in this study. Although the risk was not statistically significant, oral surgical procedures should still be cautiously provided. Attempt to limit trauma extent during procedure and well-prepared hemostatic measures without suspension of antiplatelet therapy were recommended.