Abstract
Ms. J is a 65-year-old female referred for evaluation and extraction of her remaining dentition (five periodontally involved mandibular teeth) and insertion of an immediate lower denture. She is currently asymptomatic. Her past medical history reveals that she has chronic atrial fibrillation for which she is prescribed an oral anticoagulant, Coumadin® (DuPont, Wilmington, Delaware, USA) to prevent thromboembolic episodes.
Since you do not commonly manage anticoagulated patients, you call three colleagues to solicit their opinions.
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The patient's physician recommends hospital admission and initiating intravenous heparin while tapering her warfarin
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Her cardiologist recommends discontinuing warfarin 48 hours before the procedure
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A former classmate (now an oral and maxillofacial surgeon) recommends no change in oral anticoagulant therapy and to control bleeding with local measures
You are confused with these three conflicting recommendations from knowledgeable experts whose opinions you trust and respect. Your patient needs treatment. You need to make an explicit decision regarding perioperative management of the warfarin. Which management strategy optimizes your patient's outcome?
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Dodson, T. Managing anticoagulated patients requiring dental extractions: an exercise in evidence-based clinical practice. Evid Based Dent 3, 23–26 (2002). https://doi.org/10.1038/sj.ebd.6400094
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DOI: https://doi.org/10.1038/sj.ebd.6400094
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Superfluous disclaimer
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