26, 27, 28, 29, 30, 31 There are several important modalities for local haemostasis that might be important to minimise postoperative bleeding, including tranexamic acid mouthwash, 21, 25, 26 fibrin glue, 31, 32, 33 gelatin sponge, Surgicel and sutures. Recent studies have suggested that dental extractions may be carried out with no interruption to the anticoagulant therapy provided local haemostasis is adequately maintained. 14, 15 However, owing to serious complications associated with the withdrawal of anticoagulant therapy, 16, 17, 18 the earlier protocol of temporary discontinuation of anticoagulants for oral surgery 19, 20, 21 has been modified variously to include decreasing the level of anticoagulation, 22, 23 heparin substitution 24, 25 or not altering the anticoagulant regimen. The dilemma of anticoagulant therapy administration before, during and/or after oral surgery continues to prevail, as there are different protocols which have been consistently updated. Most patients on oral anticoagulant therapy belong to the age group where high prevalence of periodontitis and other dental ailments may necessitate surgical intervention 10, 11, 12, 13 and hence the evaluation of risk of bleeding (with anticoagulation) or thromboembolism (without anticoagulation) is essential. Consequently, small errors in the ISI assignment may affect the calculated INR substantially. The ISI value is critical for calculation of the INR, because the ISI value is the exponent in the formula. 8 By definition, those more sensitive to thromboplastin have an ISI of less than 1.0 and those less sensitive are greater than 1.0. The working reference has been calibrated against internationally accepted standard reference preparations which have an ISI value of 1.0. 7 The INR was developed to incorporate the international sensitivity index (ISI) values and attempt to make prothrombin time (PT) results uniformly useable. ![]() This recommendation is supported by the American College of Chest Physicians, the National Heart, Lung and Blood Institute and the British Society for Haematology. The use of the international normalised ratio (INR) has been recommended for monitoring patients' oral anticoagulant therapy. 3, 4, 5 Warfarin, a competitive inhibitor of vitamin K, is a commonly prescribed oral anticoagulant to reduce the risk of thromboembolism in patients with mechanical heart valves, deep vein thrombosis and other hypercoagulable states. 1, 2 The principal adverse effect of oral anticoagulants is haemorrhage that may cause related complications for some patients. Oral anticoagulants are one of the most effective prophylactic/therapeutic medications to combat life-threatening thromboembolic events. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls.Ĭonclusion Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. ![]() ![]() Results Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7). Methods Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). Objectives To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |