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
