Dentaltown October 2022 - 24

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Warfarin Protocol
Townies discuss possible contraindications and considerations of a popular blood thinner
Saca_Muela
Member Since: 09/22/08
Post: 1 of 42
I work with low-income patients at a health center who cannot afford to see OMS. Some
are on warfarin regimens-any major concerns if I cover all my bases? Basically, I get a medical
referral from the doctor who gave the warfarin with when the patient should stop taking it; then
I get an INR the day before or the day of. If they are between 2.0 and 3.0, I fi gure I'm good to go.
I keep gel foam/Benacel on hand to help with clotting.
Is there some huge unknown I am missing here? Should this scare me more than it does? Are
routine/surgical extractions OK with this regimen? Is an INR the day before or the day of current
enough? Is it too strict? Should I fear other newer anticoagulantss like Eliquis more? Thanks
for your input. I just want to provide service safely for these patients who can't see a surgeon. ■
8/13/2015
jsdmd
Member Since: 07/01/10
Post: 2 of 42
Timmy G aka Nowhere Man
Member Since: 04/14/02
Post: 4 of 42
Saca_Muela
Member Since: 09/22/08
Post: 5 of 42
The INR must be taken on the day of the surgery. Do you have a medical department that
can do this for you in your clinic? ■
Stopping Coumadin therapy is no longer indicated. Signifi cantly increases the risk of pulmonary
embolism. Get a pro-time test, but only to adjust Coumadin if needed, not to stop it. ■
8/13/2015
Any recommendations on how current the test needs to be?
Does the pro-time have more weight than the INR?
For instance, her pro-time was 17.9 s, higher than the range of 9.6-12.8 s.
However, her INR was 1.8, which is in the range of 2.0-3.0.
So, would an extraction be cleared to go? INR would indicate OK, but pro-time is quite long
mnsooner
Member Since: 08/04/03
Posts: 6, 8 and 10 of 42
and out of the range of normality. ■
INR is derived from prothrombin time. Patient results are variable depending on the labo8/13/2015
8/13/2015
ratory
and the batch of test chemicals used. INR is derived using a mathematical formula based
on control results and is intended to give a standardized number that can be better compared
between different sources.
Bottom line: Rely on the INR rather than PT. The latter is subject to too much variation
depending on the chemical lot or the specifi c laboratory analyzer being used.
Do not stop the Coumadin. If the patient has an INR that is outside of the therapeutic range
(normally 2.0-3.0, but sometimes 2.5-3.5 for some purposes such as a mechanical heart valve),
communicate with the physician and let them adjust the dose if they believe it necessary.
I think that you will be OK controlling bleeding from a single tooth extraction if the INR
is below 3.5 by using local measures (pressure, sutures, excellent surgical technique, gel foam,
Surgicel, etc.). ■
8/13/2015
24 OCTOBER 2022 // dentaltown.com

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