Dentistry and anticoagulant

1. MANAGEMENT OF PATIENT WITH ANTICOAGULANT THERAPY
Anticoagulants :A substance that prevents blood from clotting by suppressing the synthesis of various clotting factors.
Targets for anticoagulant drugs
INR (InternationalNormalized Ratio) & its implication
:INR is the PT ratio(patient PT/control PT) or obtained if international reference thromboplastin reagent had been use.normal range 1, PT – 11-12 sec
 Management of patients on anticoagulants :
 it is important to proeed the dental therapy without increased the risk of post operative
bleeding. With altering increase risk of post operative bleeding.
 If decrease the PT prior the procedure ,it decrease the risk of post operative bleeding with
increase risk of CVA(cerebro vascular accidents)
 PT levels upto 2 and ½ times control is considered acceptance for surgical procedure.
 PT> 35 sec –delay the treatment, medical consultation or modify the dose.
 Precaution taken – inj. vit –k 1mg, if exessive bleeding occur,use hemostatic agents,multiple
suture given,pressure pack for 6-12 hrs,doctor available 24 hrs post treatment.
 Patient on warfarin :(its acts by inhibits vitamin K dependent clotting factors II,VII,IX,X. Long
duration of action.)
 Consult with physician regarding the safety to lowering the PT value 1 and ½ ,if not safe
hospitalized the patient and switch to heparin (if INR >3.5 ,risk present )
 If desired PT value obtain then proceed the surgery,
 If PT > 1 and ½ value , stop warfarin 2 days prior the surgery , daily monitor the PT when it
comes in one and half times o controls –proceed the surgery , ensure proper clot formation
and retraction(if INR 2.5-3.5)
 Start warfarin on the day of surgery.
Management of patients on heparin anticoagulationtherapy:
Heparin has an immediate effects on blood clotting but acts for only 4-6
hours.the effect of heparin is best assessed by APTT .Acts by activating
antithrombin iii and inactivates Xa,IIa,IXa,XIa,XIIa,and XIIIa.
• Consults the physician to determine the safty of stopping heparin
during perioperative periods.
• Delay the surgery for 6 hrs after stopping heparin or use of heparin
antagonist like protamine sulphate(strongly basic in nature)
• Start heparin once a good clot is formed.
Post-operative care
:Antifibrinolytics-
Tranexamic acid
topical
mouthwash.EACA
(250mg/ml)25%
syrup 5to 10 ml.
Oral penicillins V
250mg to 500 mg
qid for7 days
Paracetamol
choice of drugs
as no effect on
platelet.
Diet cool liquid
several days.
Patient on aspirin : consults with physician regarding stopping the aspirin for
few days. Stop the aspirin 5 days prior to surgery. Taken care of measures
during and after surgery for clot formation and retraction.
Start the medicine on day after the surgery if not bleeding occurs.