TABLE 2
FROM:
Guidelines for the management of patients who are taking oral anticoagulants and who require dental surgery
Derek Richards
BACK TO ARTICLETable 2. Key recommendations
| Recommendation | Grade of recommendation and evidence level |
|---|---|
| Risk of significant bleeding in patients taking oral anticoagulants who have stable INR in the therapeutic range 2–4 (ie, <4) is very small and the risk of thrombosis may be increased if oral anticoagulants are temporarily discontinued. Oral anticoagulants should not be discontinued in the majority of patients requiring outpatient dental surgery including dental extraction | Grade A, level Ib |
| For patients stably anticoagulated on warfarin (INR, 2–4) and who are prescribed a single dose of antibiotics as prophylaxis against endocarditis, there is no need to alter their anticoagulant regimen | Grade C, level IV |
| The risk of bleeding may be minimised by: | |
| a. Use of oxidised cellulose (Surgicel, Johnson & Johnson Medical, New Brunswick, NJ, USA or collagen sponges and sutures | Grade B, level IIb |
| b. Using 5% tranexamic acid* mouthwashes used four times/ day for 2 days | Grade A, level Ib |
| For patients who are stably anticoagulated on warfarin, a check INR is recommended 72 h before dental surgery | Grade A, level Ib |
| Patients taking warfarin should not be prescribed nonselective NSAID and COX-2 inhibitors as analgesia following dental surgery | Grade B, level III |
*Tranexamic acid is not readily available in most primary care dental practices.
INR, International normalised ratio; NSAID, nonsteroidal anti-inflammatory drugs; COX-2, cyclo-oxygenase 2 (subtype of prostaglandin-endoperoxide synthase that plays an important role in many cellular processes and inflammation).