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Surgical management of patients on warfarin sodium
1Department of Oral and Maxillofacial Surgery, University of Washington, Seattle 98195, USA.
Purpose:
Management of anticoagulated patients has changed significantly over the past 10 years. The change occurred after the introduction of the international normalized ratio (INR) in 1983. This method of reporting prothrombin time for anticoagulated patients has resulted in a decrease in the level at which hematologists and cardiologists keep their patients anticoagulated. Currently, patients are anticoagulated less for the successful prevention of thromboemboli. Recent recommendations are to keep patients anticoagulated to an INR no greater than 3.5. It has been proposed that the extraction of teeth can be performed with INRs of 4 or less. Therefore, the current trend is to maintain patients on their anticoagulation regimens without altering their warfarin dosages.
Conclusion:
With proper local measures, teeth can be extracted safely and the development of thromboemboli in high-risk patients can still be prevented. However, with procedures having a high risk of bleeding, warfarin dosage may need to be modified.