Dental extractions in patients on an oral anticoagulant: a survey of practices in North America.
OBJECTIVE
The World Health Organization (WHO) recommends the use of the International Normalized Ratio (INR) for reporting prothrombin time (PT) values. However, there are no scientifically based guidelines for performing dental extractions when using the INR. Oral and maxillofacial surgeons were surveyed to determine whether the INR is the method they use to monitor the level of anticoagulation and to determine what protocols are followed when anticoagulated patients require dental extractions.


METHODS
A mail survey of academic oral and maxillofacial surgeons in North America was conducted to determine their choice of laboratory tests for assessing patients on oral anticoagulants and their protocol before proceeding to dental extractions.


RESULTS
Fifty-three of 73 respondents (73%) routinely use the INR, but only 21% rely on this method alone. Twelve percent and 11% of respondents, respectively, also use the PT value and PT ratio. The level of anticoagulation at which surgeons would proceed with dental extractions was variable. For those using the INR, it was from 1.3 to 4.0, for those using PT ratios the perceived safe range was from 1.0 to 2.0, and for those using the PT value, the range was from 13 to 21 sec.


CONCLUSIONS
Despite the support in the medical literature for use of the INR, many oral and maxillofacial surgeons still use the PT for monitoring oral anticoagulant therapy. There is no consensus on the INR interval at which dental extractions can be safely performed. Prospective studies are needed in this area.
Division of Oral and Maxillofacial Surgery, The Montreal General Hospital, McGill University, Quebec, Canada.
M J
MJ
Troulis
T W
TW
Head
J R
JR
Leclerc
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D006801:Humans; D019934:International Normalized Ratio; D009656:North America; D017410:Practice Guidelines as Topic; D019239:Practice Patterns, Dentists'; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors; D012449:Safety; D013515:Surgery, Oral; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000517:prevention & control; D014081:Tooth Extraction; D014944:World Health Organization
D000925:Anticoagulants