Patients undergoing oral anticoagulation treatment with vitamin K antagonist (VKA) therapy are at a high risk of bleeding when undergoing an oral surgical procedure. Bridging therapy with parenteral heparin, aims to protect these patients against thromboembolism during temporary periprocedural interruption of VKA therapy. Whether or not to interrupt VKA therapy and initiate bridging therapy is a difficult decision that is based upon both the patient’s and the procedure’s risks. The management of anticoagulation in patients undergoing surgical procedures is challenging because Interruption of anticoagulation temporarily increases thromboembolic risk and potentially fatal, while, continuing anticoagulation increases the risk of bleeding associated with surgical procedures; both of these outcomes adversely affect mortality. The activity of warfarin is expressed using the International Normalized Ratio (INR). If patients on warfarin who require dental surgery have an INR of below 4.0, they can usually receive their dental treatment in primary care without needing to stop their warfarin or adjust their dose. The risk of thromboembolism after temporary withdrawal of warfarin therapy outweighs the risk of oral bleeding following dental surgery. Dentists should still be cautious before they remove teeth where the INR exceeds 3.A balance between reducing the risk of thromboembolism and preventing excessive bleeding is the keystone of successful management of such patients.
Published on: Apr 23, 2015 Pages: 17-18