{"id":31333,"date":"2026-07-09T10:37:35","date_gmt":"2026-07-09T07:37:35","guid":{"rendered":"https:\/\/bolenzdrav.com\/?p=31333"},"modified":"2026-07-09T10:40:37","modified_gmt":"2026-07-09T07:40:37","slug":"zastho-ne-biva-da-se-spirat-razrezhdasthi-kravta-lekarstva-predi-vadene-na-zab","status":"publish","type":"post","link":"https:\/\/bolenzdrav.com\/fr\/zdrave\/zastho-ne-biva-da-se-spirat-razrezhdasthi-kravta-lekarstva-predi-vadene-na-zab\/","title":{"rendered":"Pourquoi il ne faut pas interrompre la prise d'anticoagulants avant une extraction dentaire"},"content":{"rendered":"

Interrompre un traitement anticoagulant ou antiplaquettaire avant une extraction dentaire est non seulement inutile, mais aussi tr\u00e8s risqu\u00e9. Le cardiologue Alexander Nosikov a lanc\u00e9 cet appel aux m\u00e9decins et aux patients sur sa page Facebook. Sa prise de position fait suite \u00e0 une augmentation des demandes de consultation concernant l'opportunit\u00e9 d'interrompre ces traitements avant une extraction dentaire.<\/p>\n\n\n\n

Ce sont des m\u00e9dicaments qui emp\u00eachent la formation de caillots sanguins. Anticoagulants <\/a><\/strong>\u2014 par exemple, le rivaroxaban, l'apixaban, l'\u00e9doxaban, le dabigatran ou la warfarine r\u00e9duisent le risque d'accident vasculaire c\u00e9r\u00e9bral et de thrombose dans des affections telles que la fibrillation auriculaire ou la thromboembolie veineuse. Agents antiplaquettaires <\/a><\/strong>\u2014 comme l'aspirine, clopidogrel<\/a><\/strong>, Le prasugrel ou le ticagrelor sont souvent utilis\u00e9s apr\u00e8s la pose d'un stent coronaire ou en cas de risque cardiovasculaire \u00e9lev\u00e9.<\/p>\n\n\n\n

Le risque d'h\u00e9morragie lors d'une extraction dentaire est faible, tandis que le risque de thrombose en cas d'arr\u00eat incorrect du traitement peut \u00eatre catastrophique.<\/h2>\n\n\n\n
\"\u043a\u0430\u0440\u0438\u0435\u0441<\/a>
Le risque d'h\u00e9morragie lors d'une extraction dentaire peut \u00eatre facilement g\u00e9r\u00e9.<\/figcaption><\/figure>\n\n\n\n

Le principal probl\u00e8me r\u00e9side dans le fait que le risque d'h\u00e9morragie lors d'une extraction dentaire est g\u00e9n\u00e9ralement g\u00e9rable, tandis que le risque de thrombose, en cas d'arr\u00eat inappropri\u00e9 du traitement, peut \u00eatre catastrophique. L'Association dentaire am\u00e9ricaine indique que, chez la plupart des patients, il n'est pas n\u00e9cessaire de modifier le traitement anticoagulant ou antiplaquettaire avant une intervention dentaire, et que les saignements sont g\u00e9n\u00e9ralement ma\u00eetris\u00e9s par des mesures locales.<\/p>\n\n\n\n

C\u2019est pr\u00e9cis\u00e9ment l\u2019un des points essentiels de la position du Dr Nosikov\u00a0: l\u2019arr\u00eat de ces m\u00e9dicaments n\u2019est pas sans risque. Chez un patient porteur d\u2019un stent, par exemple, l\u2019arr\u00eat d\u2019un antiagr\u00e9gant plaquettaire peut entra\u00eener une thrombose de stent, c\u2019est-\u00e0-dire une obstruction aigu\u00eb et potentiellement mortelle d\u2019un vaisseau coronaire. Chez un patient souffrant de fibrillation auriculaire, un arr\u00eat inappropri\u00e9 d\u2019un anticoagulant peut accro\u00eetre le risque d\u2019accident vasculaire c\u00e9r\u00e9bral embolique. Les cons\u00e9quences peuvent \u00eatre le d\u00e9c\u00e8s ou un handicap permanent.<\/p>\n\n\n\n

\u201e Couverture \u201c temporaire \u00e0 l\u2019h\u00e9parine \u2014 pratique non standard pour tous les patients<\/h2>\n\n\n\n

Il est important de pr\u00e9ciser que les h\u00e9parines de bas poids mol\u00e9culaire, connues des patients sous des noms commerciaux tels que Clexane ou Fraxiparine, ne constituent pas un \u201e\u00a0substitut\u00a0\u201c universel. Elles ne remplacent pas les antiagr\u00e9gants plaquettaires. Quant aux anticoagulants oraux directs, le relais, ou \u201e\u00a0couverture\u00a0\u201c temporaire, par ces derniers, est un autre facteur \u00e0 consid\u00e9rer. h\u00e9parine <\/a><\/strong>\u2014 n\u2019est pas une pratique courante pour tous les patients. L\u2019American College of Cardiology souligne \u00e9galement que chez les patients sous anticoagulants oraux directs, le relais par h\u00e9parine ou h\u00e9parine de bas poids mol\u00e9culaire n\u2019est g\u00e9n\u00e9ralement pas indiqu\u00e9, car la p\u00e9riode sans anticoagulation, lorsqu\u2019elle est n\u00e9cessaire, est courte.<\/p>\n\n\n\n

En dentisterie, la d\u00e9cision d\u00e9pend de nombreux facteurs\u00a0: les m\u00e9dicaments que prend le patient, la raison de ce traitement, la date de pose du stent, la pr\u00e9sence d\u2019une fibrillation auriculaire, d\u2019ant\u00e9c\u00e9dents d\u2019AVC ou d\u2019insuffisance r\u00e9nale, d\u2019un risque h\u00e9morragique \u00e9lev\u00e9, le type d\u2019extraction pratiqu\u00e9e et le type d\u2019anesth\u00e9sie utilis\u00e9. Par cons\u00e9quent, il n\u2019existe pas de protocole unique et s\u00fbr applicable \u00e0 tous.<\/p>\n\n\n\n

Les recommandations actuelles consid\u00e8rent la plupart des interventions dentaires mineures comme des interventions \u00e0 faible risque. Une \u00e9tude de 2024 a not\u00e9 que, pour la plupart des interventions dentaires mineures, le traitement antiplaquettaire ou anticoagulant peut \u00eatre poursuivi sans interruption et que des mesures h\u00e9mostatiques locales \u2014 telles que la compression, les sutures, les agents h\u00e9mostatiques topiques ou les bains de bouche \u00e0 l'acide tranexamique \u2014 sont utilis\u00e9es au besoin.<\/p>\n\n\n\n

Certains patients peuvent avoir besoin de sauter une dose ou de retarder une dose.<\/h2>\n\n\n\n
\"\u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430<\/a><\/figure>\n\n\n\n

Cela ne signifie pas qu'une modification du traitement est impossible. Chez certains patients et pour les interventions \u00e0 haut risque, il peut \u00eatre n\u00e9cessaire de sauter une dose, de retarder son administration ou de prolonger l'intervalle entre les prises. Toutefois, cette d\u00e9cision doit \u00eatre prise au pr\u00e9alable par un m\u00e9decin connaissant le risque cardiovasculaire du patient. Les recommandations du SDCEP insistent \u00e9galement sur la n\u00e9cessit\u00e9 d'une \u00e9valuation sp\u00e9cifique en fonction du m\u00e9dicament, de l'intervention et du risque h\u00e9morragique.<\/p>\n\n\n\n

Le conseil pratique aux patients est clair\u00a0: n\u2019interrompez pas vous-m\u00eame votre traitement anticoagulant ou antiplaquettaire avant une extraction dentaire. Si le dentiste ou le chirurgien estime qu\u2019il existe un risque h\u00e9morragique, il doit demander une consultation pr\u00e9op\u00e9ratoire avec un cardiologue. Lors de cette consultation, le d\u00e9roulement de l\u2019intervention, le risque h\u00e9morragique attendu et le type d\u2019anesth\u00e9sie seront d\u00e9crits. Ce n\u2019est qu\u2019apr\u00e8s cette consultation que le cardiologue pourra formuler une recommandation \u00e9crite quant \u00e0 la poursuite ou la modification temporaire du traitement, ou encore au report de l\u2019intervention.<\/p>\n\n\n\n

L'extraction dentaire n'est g\u00e9n\u00e9ralement pas une intervention d'urgence. Par cons\u00e9quent, la solution la plus s\u00fbre consiste \u00e0 prendre la d\u00e9cision en temps opportun \u2014 non pas le jour m\u00eame de l'intervention ni par simple message, mais apr\u00e8s un v\u00e9ritable examen m\u00e9dical.<\/p>\n\n\n\n

Editeur Ina Dimitrova<\/p>","protected":false},"excerpt":{"rendered":"

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[…]<\/p>\n","protected":false},"author":3,"featured_media":30198,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5235],"tags":[453,4990,5131],"class_list":{"0":"post-31333","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-zdrave","8":"tag-antikoagulanti","9":"tag-vadene-na-zab","10":"tag-klopidogrel"},"yoast_head":"\n\u0417\u0430\u0449\u043e \u043d\u0435 \u0431\u0438\u0432\u0430 \u0434\u0430 \u0441\u0435 \u0441\u043f\u0438\u0440\u0430\u0442 \u0440\u0430\u0437\u0440\u0435\u0436\u0434\u0430\u0449\u0438 \u043a\u0440\u044a\u0432\u0442\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430 \u043f\u0440\u0435\u0434\u0438 \u0432\u0430\u0434\u0435\u043d\u0435 \u043d\u0430 \u0437\u044a\u0431 - bolenzdrav.com<\/title>\n<meta name=\"description\" content=\"\u0417\u0430\u0449\u043e \u043d\u0435 \u0431\u0438\u0432\u0430 \u0434\u0430 \u0441\u0435 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