![]() A full patient’s history was taken from all patients in accordance with the patient’s file at the OMF department, which includes a whole system review and detailed patient history and examination. In this study, we aimed to investigate the risk of bleeding after simple dental extraction in patients taking warfarin regularly and whose INR is below 4.0.Īll patients included in this study were undergoing warfarin treatment and were referred to the Department of Oral and Maxillofacial Surgery (OMF) for simple dental extraction. 16 Assessing both risks and benefits is very important in patients receiving warfarin, and a very close communication and consultation with the patient’s physician regarding the best management is critical. Suspension of warfarin treatment may be responsible for the development of CVA in patients undergoing dental extractions. 3, 14, 15 It has, however, been debated whether stopping warfarin can increase the risk of cerebrovascular accidents (CVA). 12 Many reports stated that patients requiring a minor dental procedure and having an INR of up to 4.0 are able to continue warfarin without any dose adjustment. 12, 13 Heparin is used in anticoagulation bridge therapy, as it has a faster onset and offset action compared with warfarin. These include stopping warfarin 2–3 days before the procedure, reducing warfarin dose, continuing warfarin, and measuring the INR and replacing warfarin with low molecular weight heparin (anticoagulation bridge therapy) in an outpatient clinic or hospital setting. 9– 11Ī range of strategies has been used to manage patients undergoing warfarin treatment before surgical procedures. 8 The risk of postsurgical bleeding in patients taking warfarin was reported to be very low in cases of dental extractions, providing that the INR was within an acceptable range when major bleeding does however occur, it can be uncontrollable with local measures and need hospital management. 7 The percentage of bleeding in sites outside the central nervous system was reported to be 7.3%. The percentage of intracranial hemorrhage in the first 3 months after treatment with warfarin was found to be 1.48% with annual percentage of 0.65% 6 this risk was, however, considered unlikely. Such risk of bleeding has been found to be related to many factors, including the intensity of the anticoagulation and in some patients, related factors including age, hypertension, severe cardiac disease, and renal insufficiency. 5 It has been found that the annual rate of major bleeding in case of patients with atrial fibrillation who receive warfarin treatment is between 0.4 and 2.6. The reported percentage of major bleeding which can be life-threatening in patients taking warfarin ranges from 0.4 to 7.2%, while for minor bleeding, the percentage is approximately 15.4. ![]() The recommended INR level according to the American College of Chest Physicians is between 2.0 and 3.0 for most conditions 4 however, patients using prosthetic heart valves may require higher level of INR.Īnticoagulant drugs may put the patient under a risk of bleeding following surgical procedures, and as a result, surgeons are always worried about bleeding in patients undergoing warfarin treatment. 3 The level of INR suitable for the patient depends on the condition of the patient. Its effect is measured by international normalized ratio (INR), which is a measure of patient’s prothrombin time divided by the laboratory control value of prothrombin time. Warfarin has been used to decrease the thromboembolism in millions of patients worldwide. 2 The liver metabolizes warfarin into inactive compounds, which are then excreted, mainly into the urine. 1 Albumin is bound to circulating warfarin, and the half-life of warfarin is approximately 36 hours. The drug can be absorbed completely and reaches its peak in 1 hour after ingestion. Warfarin, which acts by antagonizing the effect of vitamin K, is one of the most commonly used oral anticoagulants.
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