口服抗凝血藥物與牙齦異常出血－病例報告

一位68歲男性患者，過去病史為慢性風濕性心臟病及長期服用抗凝血藥物warfarin（Coumadin®）5 mg。2011年9月10日到本院牙周病科就診，主述為全口牙齦腫脹及異常出血，臨床理學檢查發現患者口內有明顯牙結石堆積，牙齦多處紅腫發炎，口腔衛生狀況不佳。2011年9月2日於本院血液檢查凝血酶原時間（PT）=37.8秒（參考值：9.9 ~ 12.0秒），INR=3.3（參考值：2.0 ~ 3.0），懷疑主述牙齦異常出血與其牙周狀況及服用抗凝血藥物有高度相關。遂即進行全口X光片及牙周基本檢查，口腔衛教並會診心臟內科醫師，諮詢停藥五天後進行全口非手術性牙周病治療，有效解決患者牙齦腫脹及異常出血不止的問題。治療牙齦異常出血的患者前，需詳問個人疾病史、藥物史，必要時會診其他科，裨益牙周病治療進行。

關鍵字

口服抗凝血藥物；牙齦異常出血

並列摘要

A 68-year-old male with a medical history of chronic rheumatic heart disease came to our periodontal clinic with full mouth gingival swelling and gingival bleeding disorders on the 9/10/2011. He had been taking an anticoagulant, namely Warfarin (Coumadin®) 5 mg, for a long time. Heavy calculous deposition over the gingival margin, redness, a swelling of inflammatory gingiva and poor oral hygiene were noted during the intraoral physical examination. His blood tests on the 9/2/2011 showed a prolonged prothrombin time (PT) of 37.8 seconds (normal time=9.9 ~ 12.0 sec) and an INR=3.3 (normal=2.0 ~ 3.0). We suspected that the gingival bleeding was closely related to his periodontal condition and his medicine history of anticoagulant use. A periodontal probing examination together with oral hygiene instruction were performed right away. After consulting his cardiologist, the patient discontinued the anticoagulant for five days and then received full mouth non-surgical periodontal treatment. The gingival swelling and bleeding were improved significantly. Taking detailed information regarding a patient's past medical history and their history of drug use is necessary, especially before treating gingival bleeding disorders. Consultation with medical specialists in order to evaluate the effect of anticoagulant use plays an important role in the periodontal treatment.

並列關鍵字

oral anticoagulant ； gingival bleeding disorders ； warfarin

國際替代計量

口服抗凝血藥物與牙齦異常出血－病例報告

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