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Table of Contents   
LETTER TO EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 6  |  Page : 836-837
Oral anticoagulant therapy


Department of Oral Pathology and Microbiology, KD Dental College and Hospital, Mathura, India

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Date of Web Publication3-May-2013
 

How to cite this article:
Agarwal P. Oral anticoagulant therapy. Indian J Dent Res 2012;23:836-7

How to cite this URL:
Agarwal P. Oral anticoagulant therapy. Indian J Dent Res [serial online] 2012 [cited 2020 Nov 28];23:836-7. Available from: https://www.ijdr.in/text.asp?2012/23/6/836/111278
Sir,

When patients are scheduled for minor oral surgery procedure, a question is raised: "what should we do with the oral anticoagulant (OAC) therapy?" We face the dilemma between the risk of discontinuing the medication and the patient developing thrombosis, or the continuation of the medication and patient bleeding postoperatively. Serious embolic complications, including death, are three times more likely to occur in patients whose anticoagulant therapy is interrupted than are the bleeding complications in patients whose anticoagulant therapy is continued.

OAC has been used to decrease the risk of thromboembolism. Dental treatment on anticoagulated patients has been controversial and physicians must weigh the risks of hemorrhage from the dental procedure against the risks of emboli from withdrawing the anticoagulation treatment. [1],[2] Warfarin is the main medication used in OAC therapy, and is ranked 29 among the top 200 prescribed medications in the USA. [3]

The bleeding time, prothrombin time (PT) and activated partial thromboplastin time (APTT), have been the standards based on which clinicians evaluate anticoagulation levels. Nevertheless, an international normalized ratio (INR) was introduced in 1983 by the World Health Organization Committee on Biological Standards to assess the patients receiving anticoagulation therapy more accurately. [4]

A patient with a normal coagulation profile would have an INR of 1.0. It is recommended that a patient undergoing invasive treatment should have a PT within 1.5-2.0 times the normal value, and this corresponds to an INR of 1.5-2.5 when the international sensitivity index value (ISI) is 1.0. [5] In patients with anticoagulant therapy, an INR between 2.0 and 3.0 is recommended for most indications. Thus, an INR of 2.5 (range 2.0-3.0) minimizes the risk of either hemorrhage or thromboembolism. [5]

Dentists should advice their patients to continue therapeutic levels of anticoagulation, but if the patient and physician insist, then it should be the physician who withdraws the anticoagulant therapy and the dentist who performs the dentistry. Similarly, if more than local measures are required to control bleeding after dental surgery, the physician should be involved. Good surgical technique and appropriate local measures to control bleeding are important for all dental patients, especially those receiving continuous anticoagulant therapy. [6]

 
   References Top

1.Herman WW, Konzelman JL Jr, Sutley SH. Current perspectives on dental patients receiving coumarin anticoagulant therapy. J Am Dent Assoc 1997;128:327-35.  Back to cited text no. 1
    
2.Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med 1998; 158:1610-6.  Back to cited text no. 2
    
3.Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 8 th ed. Chest 2008;133:546-92.  Back to cited text no. 3
    
4.Hirsh J, Poller L. The international normalized ratio. A guide to understanding and correcting its problems. Arch Intern Med 1994;154:282-8.  Back to cited text no. 4
    
5.Hirsh J, Dalen J, Anderson DR, Poller L, Bussey H, Ansell J, et al. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001;119:8-21.  Back to cited text no. 5
    
6.Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc 2000;131:77-81.  Back to cited text no. 6
    

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Correspondence Address:
Pankaj Agarwal
Department of Oral Pathology and Microbiology, KD Dental College and Hospital, Mathura
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.111278

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