中国循证医学杂志

中国循证医学杂志

华法林对拔牙术后出血并发症影响的 Meta 分析

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目的 系统评价华法林对拔牙术后出血的影响。 方法 计算机检索 PubMed、EMbase、The Cochrane Library(2016 年 9 期)、CNKI、VIP 和 WanFang Data 数据库以及中国国家药品不良反应监测系统和美国 FDA 药品不良反应监测系统,搜集关于华法林对拔牙术后出血影响的随机对照试验和队列研究,检索时限均为建库到 2016 年 9 月 30 日。由两位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 共纳入 8 个研究,其中 3 个为 RCTs,5 个为队列研究。Meta 分析结果显示:停用或减量华法林组与不停用华法林组在拔牙术后出血并发症发生率方面,其差异无统计学意义[RCTs:RR=0.86,95%CI(0.49,1.51),P=0.60;队列研究:RR=0.67,95%CI(0.45,1.01),P=0.06]。 结论 当前证据表明,停服华法林与否和拔牙术后出血并发症之间并无显著性关联。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the effect of discontinuous warfarin on the risk of postoperative bleeding complications after tooth extractions. Methods PubMed, EMbase, The Cochrane Library (Issue 9, 2016), CNKI, VIP, WanFang Data, China Food and Drug Administration and the ADR supervision system of FDA were electronically searched to collect randomized controlled trials (RCTs) and cohort studies about the effect of discontinuous warfarin on risk of postoperative bleeding complications after tooth extractions in patients until September 30th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included, involving 3 RCTs and 5 cohort studies. The results of meta-analysis showed that: there was no significant difference between the discontinuous or reduced warfarin group and continuous warfarin group [RCTs: RR=0.86, 95%CI (0.49, 1.51),P=0.60; cohort studies: RR=0.67, 95%CI (0.45, 1.01),P=0.06]. Conclusions Current evidence indicates that there is no statistically significant correlation between whether discontinuous warfarin and the risk of postoperative bleeding complications after tooth extractions. Due to the limited quantity and quality of included studies, the above conclusions are needed to be further verified by more high quality studies.

关键词: 华法林; 拔牙; 出血; Meta 分析

Key words: Warfarin; Tooth extraction; Bleeding; Meta-analysis

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