{"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\/pl\/zdrave\/zastho-ne-biva-da-se-spirat-razrezhdasthi-kravta-lekarstva-predi-vadene-na-zab\/","title":{"rendered":"Dlaczego nie nale\u017cy przerywa\u0107 stosowania lek\u00f3w rozrzedzaj\u0105cych krew przed ekstrakcj\u0105 z\u0119ba"},"content":{"rendered":"

Odstawienie lek\u00f3w przeciwzakrzepowych lub przeciwp\u0142ytkowych przed ekstrakcj\u0105 z\u0119ba jest nie tylko niepotrzebne, ale i bardzo ryzykowne. Kardiolog dr Aleksander Nosikow zwr\u00f3ci\u0142 si\u0119 z tym apelem do lekarzy i pacjent\u00f3w na swoim profilu na Facebooku. Jego stanowisko zosta\u0142o zainspirowane rosn\u0105c\u0105 liczb\u0105 pr\u00f3\u015bb o konsultacje dotycz\u0105ce konieczno\u015bci odstawienia takich lek\u00f3w przed ekstrakcj\u0105 z\u0119ba.<\/p>\n\n\n\n

S\u0105 to leki zapobiegaj\u0105ce tworzeniu si\u0119 skrzep\u00f3w krwi. Leki przeciwzakrzepowe <\/a><\/strong>\u2014 na przyk\u0142ad rywaroksaban, apiksaban, edoksaban, dabigatran lub warfaryna, zmniejszaj\u0105 ryzyko udaru i zakrzepicy w takich schorzeniach, jak migotanie przedsionk\u00f3w lub \u017cylna choroba zakrzepowo-zatorowa. Leki przeciwp\u0142ytkowe <\/a><\/strong>\u2014 jak aspiryna, klopidogrel<\/a><\/strong>, prasugrel lub tikagrelor \u2014 s\u0105 cz\u0119sto stosowane po wszczepieniu stentu wie\u0144cowego lub w przypadku wysokiego ryzyka sercowo-naczyniowego.<\/p>\n\n\n\n

Ryzyko krwawienia podczas usuwania z\u0119ba jest niewielkie, ale ryzyko zakrzepicy, je\u015bli leczenie zostanie przerwane nieprawid\u0142owo, mo\u017ce by\u0107 katastrofalne w skutkach.<\/h2>\n\n\n\n
\"\u043a\u0430\u0440\u0438\u0435\u0441<\/a>
Ryzyko krwawienia podczas usuwania z\u0119ba mo\u017cna \u0142atwo kontrolowa\u0107.<\/figcaption><\/figure>\n\n\n\n

G\u0142\u00f3wnym problemem jest to, \u017ce ryzyko krwawienia podczas ekstrakcji z\u0119ba jest zazwyczaj mo\u017cliwe do opanowania, podczas gdy ryzyko zakrzepicy w przypadku nieprawid\u0142owego przerwania terapii mo\u017ce by\u0107 katastrofalne. Ameryka\u0144skie Towarzystwo Stomatologiczne stwierdza, \u017ce u wi\u0119kszo\u015bci pacjent\u00f3w nie ma potrzeby zmiany leczenia przeciwzakrzepowego lub przeciwp\u0142ytkowego przed zabiegiem stomatologicznym, a krwawienie zazwyczaj udaje si\u0119 opanowa\u0107 miejscowo.<\/p>\n\n\n\n

To w\u0142a\u015bnie jeden z wa\u017cniejszych argument\u00f3w dr. Nosikowa: zaprzestanie podawania tych lek\u00f3w nie jest nieszkodliwe. Na przyk\u0142ad u pacjenta ze stentem, zaprzestanie podawania leku przeciwp\u0142ytkowego mo\u017ce prowadzi\u0107 do zakrzepicy w stencie \u2013 ostrego, zagra\u017caj\u0105cego \u017cyciu zatoru naczynia wie\u0144cowego. U pacjenta z migotaniem przedsionk\u00f3w, nieprawid\u0142owe zaprzestanie podawania leku przeciwzakrzepowego mo\u017ce zwi\u0119kszy\u0107 ryzyko udaru m\u00f3zgu zatorowego. Konsekwencj\u0105 mo\u017ce by\u0107 \u015bmier\u0107 lub trwa\u0142e kalectwo.<\/p>\n\n\n\n

Tymczasowe \u201eprzykrycie\u201c heparyn\u0105 \u2013 nie jest standardow\u0105 praktyk\u0105 dla ka\u017cdego pacjenta<\/h2>\n\n\n\n

Nale\u017cy wyja\u015bni\u0107, \u017ce heparyny drobnocz\u0105steczkowe, znane pacjentom pod nazwami handlowymi takimi jak Clexane czy Fraxiparine, nie s\u0105 uniwersalnym \u201esubstytutem\u201c. Nie zast\u0119puj\u0105 one lek\u00f3w przeciwp\u0142ytkowych. W przypadku bezpo\u015brednich doustnych antykoagulant\u00f3w, tzw. pomost \u2013 tymczasowe \u201epokrycie\u201c heparyna <\/a><\/strong>\u2014 nie jest standardow\u0105 praktyk\u0105 dla ka\u017cdego pacjenta. Ameryka\u0144skie Kolegium Kardiologiczne podkre\u015bla r\u00f3wnie\u017c, \u017ce u pacjent\u00f3w przyjmuj\u0105cych bezpo\u015brednie doustne leki przeciwzakrzepowe zazwyczaj nie ma sensu leczenie pomostowe heparyn\u0105 lub heparyn\u0105 drobnocz\u0105steczkow\u0105, poniewa\u017c okres bez antykoagulacji, o ile w og\u00f3le jest potrzebny, jest kr\u00f3tki.<\/p>\n\n\n\n

W przypadku zabieg\u00f3w stomatologicznych decyzja zale\u017cy od wielu czynnik\u00f3w: jakie leki przyjmuje pacjent, dlaczego je przyjmuje, kiedy wszczepiono stent, czy wyst\u0119puje u niego migotanie przedsionk\u00f3w, udar m\u00f3zgu, choroba nerek, wysokie ryzyko krwawienia, rodzaj przeprowadzanej ekstrakcji oraz jakie znieczulenie zostanie zastosowane. Dlatego nie ma jednego, bezpiecznego schematu leczenia, kt\u00f3ry sprawdzi\u0142by si\u0119 u wszystkich.<\/p>\n\n\n\n

Obecne wytyczne uznaj\u0105 wi\u0119kszo\u015b\u0107 drobnych zabieg\u00f3w stomatologicznych za interwencje niskiego ryzyka. Przegl\u0105d z 2024 roku wykaza\u0142, \u017ce w przypadku wi\u0119kszo\u015bci drobnych zabieg\u00f3w stomatologicznych leczenie przeciwp\u0142ytkowe lub przeciwzakrzepowe mo\u017cna kontynuowa\u0107 bez przerwy, a w razie potrzeby stosuje si\u0119 miejscowe \u015brodki hemostatyczne \u2013 takie jak ucisk, szwy, miejscowe \u015brodki hemostatyczne lub p\u0142yn do p\u0142ukania jamy ustnej z kwasem traneksamowym.<\/p>\n\n\n\n

Niekt\u00f3rzy pacjenci mog\u0105 musie\u0107 pomin\u0105\u0107 dawk\u0119 lub j\u0105 op\u00f3\u017ani\u0107<\/h2>\n\n\n\n
\"\u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430<\/a><\/figure>\n\n\n\n

Nie oznacza to, \u017ce nigdy nie dokonuje si\u0119 zmiany terapii. U niekt\u00f3rych pacjent\u00f3w i w przypadku zabieg\u00f3w o podwy\u017cszonym ryzyku mo\u017ce by\u0107 konieczne pomini\u0119cie dawki, op\u00f3\u017anienie jej podania lub d\u0142u\u017csza przerwa. Nale\u017cy to jednak oceni\u0107 wcze\u015bniej przez lekarza, kt\u00f3ry zna ryzyko sercowo-naczyniowe pacjenta. Wytyczne SDCEP podkre\u015blaj\u0105 r\u00f3wnie\u017c potrzeb\u0119 szczeg\u00f3\u0142owej oceny w zale\u017cno\u015bci od leku, zabiegu i ryzyka krwawienia.<\/p>\n\n\n\n

Praktyczne zalecenia dla pacjent\u00f3w s\u0105 jasne: nie nale\u017cy samodzielnie przerywa\u0107 przyjmowania lek\u00f3w przeciwzakrzepowych ani przeciwp\u0142ytkowych przed ekstrakcj\u0105 z\u0119ba. Je\u015bli stomatolog lub chirurg uwa\u017ca, \u017ce istnieje ryzyko krwawienia, powinien poprosi\u0107 o konsultacj\u0119 przedoperacyjn\u0105 z kardiologiem, podczas kt\u00f3rej zostanie om\u00f3wiony przebieg zabiegu, przewidywane ryzyko krwawienia oraz rodzaj znieczulenia. Dopiero wtedy kardiolog mo\u017ce wyda\u0107 pisemn\u0105 rekomendacj\u0119 dotycz\u0105c\u0105 kontynuacji, tymczasowej zmiany terapii lub prze\u0142o\u017cenia zabiegu.<\/p>\n\n\n\n

Ekstrakcja z\u0119ba najcz\u0119\u015bciej nie jest zabiegiem nag\u0142ym. Dlatego najbezpieczniej jest podj\u0105\u0107 decyzj\u0119 w odpowiednim czasie \u2013 nie w dniu zabiegu i nie w kr\u00f3tkim komunikacie, ale po rzetelnej ocenie medycznej.<\/p>\n\n\n\n

Redaktor Ina Dimitrowa<\/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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