BOF:
26
A 63
year old male who is on warfarin for atrial fibrillation is due to have a
tooth extraction. His anticoagulation is well controlled and he has not had
any recent change in medication.
What
advice would you give prior to the procedure?
a)
Continue with warfarin
b)
Switch
to aspirin
c)
Switch
to sc heparin
d)
Switch
to LMWH
e)
Stop
warfarin for 72 hours
Answer: a)
Dental
Procedures and Anticoagulation
ü
Risk
of significant bleeding in patients
•
Oral
anticoagulants
•
Stable
INR in the therapeutic range 2-4 ( <4)
Very
small
ü
Risk
of thrombosis
•
Increased in patients in whom oral anticoagulants are temporarily discontinued
ü
Oral
anticoagulants should not be discontinued in the majority of patients
requiring out-patient dental surgery
•
Including dental extraction
Recommendation
ü
Patients stably anticoagulated on warfarin (INR 2-4)
ü
Prescribed a single dose of antibiotics as prophylaxis against endocarditis
•
No
necessity to alter anticoagulant regimen \
Risk of bleeding may be minimised by
ü
Oxidised cellulose (Surgicel)
ü
Collagen sponges and sutures
ü
Tranexamic acid mouthwashes used four times a day for 2 days
Patients who are stably anticoagulated on warfarin
ü
Check
INR 72 hours prior to dental surgery
ü
No
NSAIDs and COX-2 inhibitors
Revision Tip
Revise
thrombophilia KEYS to SUCCESS in Medicine
page 419-421
