[Use of oral anticoagulants in outpatient setting]

Oral anticoagulants (OAC) have been used for more than 60 years and are being prescribed to a steadily increasing number of patients as a life-long therapy The Intenational Normalized Ratio (INR) is used to evaluate the efficacy of anti-coagulant therapy. The risk of thromboembolic and haemorrhagic complications increases when the INR is above the therapeutic range. The aim of our study was to provide information about oral anticoagulant therapy and how to treat patients on OAC therapy in specific situations such as: pregnancy, intramuscular injection, tooth extraction and small invasive procedures performed in outpatient setting. INR needs to be frequently monitored during treatment and in many countries this is done in specialist anticoagulant clinics. Such clinics do not presently exist in Poland and patients on OAC treatment typically fall under the care of doctors of different specialization including general practitioners. OAC therapy is safe until fourth--sixth week of pregnancy, after his time anticoagulant treatment should be replaced by heparins. Intramuscular injections are contra-indicated during OAC therapy. In most cases general dental treatment and straightforward single dental extractions can be performed without discontinuing OAC, provided INR is in the therapeutic range of 2,0-3,5. Risk of bleeding can be minimized by the use of mouthwashes (used three or four times a day for 2 days) containing 4,8% tranexamid or 25% e-aminocapronicum acid. Prior to undergoing invasive procedures with a middle risk of bleeding and single extraction in patients with a risk of major bleeding should consult with a physician specializing in the use of anticoagulants to discuss the treatment and to assess the risk of bleeding and thromboembolism. This is why education about the therapeutic range of INR and procedures which need to be adopted in specific situations, is very important and the educational programme on OAC therapy should be targeted at patients and doctors of different specialization including general practitioners.