anticoagulation guidelines
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7/27/2019 Anticoagulation Guidelines
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Oral Health & Diagnostic Sciences
Division of Oral Medicine
Anticoagulation Guidelines
Questions to Ask / Necessary InformationReasons for agent (warfarin, Coumadin), dosage, how often monitored, stabilityof dosage over time, most recent INR value/date, any complications, anticipated
time that will be on medication
Be Alert For:Increased clinical bleeding, urgency of treatment, presence of local factors thatincrease the potential for hemorrhage, block anesthesia requirement, number ofanticipated visits
Diagnostic Tests:INR < 3.5 (Expected range for most indications 2.0 - 3.0, for prosthetic heartvalves 2.5 - 3.5)Laboratory results should be available within last 2 days for all surgical
procedures
Management During Dental Treatment:For Routine Dental Treatment
1. Dental care should be coordinated with normal monitoring of patientsINR by physician. This commonly is done every 4-6 weeks.
2. All care may be safely performed without altering anticoagulation levels upto INR 3.5.
3. For patients on short term anticoagulation therapy, it might beappropriate to defer dental treatment until after cessation of therapy.
4. Block anesthesia poses risk of excessive, difficult to control, hemorrhageand needs to done carefully.
5. Infiltration and periodontal ligament injections are particularly well suitedfor patients with deficiencies of coagulation.
6.For Surgical Procedures Including Initial Root Planing of Patients with ExtensiveDisease
1. Confirm INR value < 3.5 within 48 hours of surgery2. Most surgical procedures can be safely performed if INR < 3.53. For extensive surgical procedures individualize treatment and consider (in
consultation with physician) reduction of anticoagulation using partialwithdrawal protocol to INR 3.0 or less. There is rarely an indication forcomplete elimination of anticoagulation.
4. Consideration should be given to subdividing extensive procedures intosmaller surgeries to minimize risk of hemorrhage.
Postoperative Management1. Avoid ASA, NSAIDs for analgesia. Use acetaminophen for postoperative
pain control.2. Make sure hemorrhage is under control before dismissing the patient.3. Many medications including common antibiotics affect the anticoagulation
July 2008
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7/27/2019 Anticoagulation Guidelines
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Oral Health & Diagnostic Sciences
Division of Oral Medicine
produced by warfarin.4. Give clear/ complete post-operative instructions including after hours
contact information.
References:
Little, Falace. The dental management of the medically compromised patient.Seventh edition. Mosby, 2008.Rhodus, Miller. Clinicians guide: the medically complex dental patients. Thirdedition B.C. Decker, 2008.
July 2008