The Journal of the Korean dental association (대한치과의사협회지)

The Korean Dental Association (대한치과의사협회)
권호 표지

Management of Dental Patients taking Warfarin

와파린(Warfarin) 투여 환자의 치과 치료

  • Park, Kwan-Soo (Department of Oral and Maxillofacial Surgery, Inje University Sanggye-Paik Hospital)
  • 박관수 (인제대학교 상계백병원 구강악안면외과)
  • Published : 2019.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Warfarin is an anticoagulant involved in the production of vitamin K dependent blood clotting factors. Dentists should be familiar with the appropriate assessment methods and considerations for the treatment of patients taking warfarin. Dental surgery with the moderate risk of bleeding can be performed without stopping the drug through preoperative examination of the INR(international normalized ratio) value and evaluation. When performing a surgery with a high risk of bleeding, it is necessary to evaluate whether the drug can be discontinued, what the duration is, and the risk of discontinuation. Hemostasis can be obtained by local methods in most cases of postoperative bleeding in patients taking appropriately adjusted doses of warfarin.

Keywords

References

  1. 유철주. 혈액응고 기전에 대한 고찰. J Kor Soc Neonatol 2011;18:1-5. https://doi.org/10.5385/jksn.2011.18.1.1
  2. Robert HR et al. Molecular biology and biochemistry of the coagulation factors and pathways of hemostasis. In: Lichtman M, Beutler E, Kaushansky K, Kipps T, Seligsohn U, Prchal J, editors. Williams hematology. 7th ed. New York: McGraw-Hill, 2006:1655-93.
  3. 정경원, 박무인. 새로운 경구용 항응고제 중에 어떤 약이 가장 안전한가?: 위장관 출혈을 기준으로. Korean J Gastroenterol 2017; 69:328-331. https://doi.org/10.4166/kjg.2017.69.5.328
  4. Febbo A. et al. Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated With Warfarin. J Oral Maxillofac Surg 2016; 74:1518-1523. https://doi.org/10.1016/j.joms.2016.04.007
  5. Lockhart PB et al. Dental management considerations for the patient with an acquired coagulopathy. Part II. Coagulopathies from drugs. Br Dent J. 2003; 195:495-501. https://doi.org/10.1038/sj.bdj.4810660
  6. Ansell et al. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl 3):204S-233S. https://doi.org/10.1378/chest.126.3_suppl.204S
  7. Brennan MT et al. Utility of an international normalized ratio testing device in a hospital-based dental practice. J Am Dent Assoc. 2008;139:697-703. https://doi.org/10.14219/jada.archive.2008.0251
  8. Nematullah A et al. Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. J Can Dent Assoc. 2009; 75:41-41i.
  9. Bacci C et al. Management of dental extraction in patients undergoing anticoagulant treatment: results from a large, multicentre, prospective, case-control study. Thromb Haemost. 2010; 104:972-975. https://doi.org/10.1160/TH10-02-0139
  10. Hong CH et al. Risk of postoperative bleeding after dental procedures in patients on warfarin: a Retrospective Study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:464-468. https://doi.org/10.1016/j.oooo.2012.04.017
  11. Douketis JD et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 ;141(2 Suppl):e326S-e350S. https://doi.org/10.1378/chest.11-2298
  12. Jacques Baillargeon et al. Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults. Am J Med. 2012; 125:183-189. https://doi.org/10.1016/j.amjmed.2011.08.014
  13. Kyung Hee Choi et al. Risk Factors of Drug Interaction between Warfarin and Nonsteroidal Anti-Inflammatory Drugs in Practical Setting. J Kor Med Sci. 2010; 25:337-341. https://doi.org/10.3346/jkms.2010.25.3.337
  14. Lopes RD et al. Warfarin and acetaminophen interaction: a summary of the evidence and biologic plausibility. Blood. 2011;118:6269-6273 epub. https://doi.org/10.1182/blood-2011-08-335612
  15. Caldeira D, Costa J, Barra M, Pinto FJ, Ferreira JJ. How safe is acetaminophen use in patients treated with vitamin K antagonists? A systematic review and meta-analysis. Thromb Res. 2015;135(1):58-61. https://doi.org/10.1016/j.thromres.2014.10.011
  16. Eisenstein DH. Anticoagulation management in the ambulatory surgical setting. AORN J. 2012; 95:510-521. https://doi.org/10.1016/j.aorn.2012.01.018