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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Pub Med、EMbase、The Cochrane Library(2016年9期)、CNKI、VIP和Wan Fang 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,检索时限均为建库至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Rev Man 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并无具有统计学意义的相关性。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 evaluate the effect of warfarin on bleeding after tooth extraction. Methods We searched Pub Med, EMbase, The Cochrane Library (2016 issue 9), CNKI, VIP and Wan Fang Data database, as well as China’s National Adverse Drug Reaction Monitoring System and the FDA’s Adverse Drug Reaction Monitoring System. We collected data on the effects of warfarin on tooth extraction Postoperative bleeding effects of randomized controlled trials and cohort studies, retrieval time are built to September 30, 2016. After two reviewers independently screened the literature, extracted data, and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included, of which 3 were RCTs and 5 were cohort studies. Meta-analysis showed no significant difference in the incidence of bleeding complications after withdrawal or warfarin between the warfarin group and the non-stop warfarin group [RCTs: RR = 0.86,95% CI ( 0.49, 1.51), P = 0.60; cohort study: RR = 0.67, 95% CI (0.45, 1.01), P = 0.06]. Conclusions The current evidence indicates that there is no statistically significant correlation between stopping warfarin or not and bleeding complications after tooth extraction. Due to the limited number and quality of studies included, the above conclusions have yet to be validated by more high-quality studies.