Management of anticoagulation in patients with prosthetic heart valves undergoing oral and maxillofacial operations.
There is wide variation in the management of patients with mechanical prosthetic valves who are taking anticoagulants and who require non-cardiac surgery. In this paper, we outline a pragmatic, practical approach to the adjustment of anticoagulation in relation to both the degrees of surgical trauma during oral and maxillofacial surgery and the risk of thromboembolism associated with the prosthetic valve. For minor surgery, no adjustment of anticoagulation is undertaken if the International Normalized Ratio is less than 4.0, if local haemostatic methods and tranexamic acid mouthwashes are used. For major surgery, warfarin is stopped preoperatively and low-molecular-weight heparin is used. For emergency surgery, partial reversal of anticoagulation with low-dose parenteral vitamin K is obtained.
Webster
K
K
Department of Oral & Maxillofacial Surgery, Haemostasis and Thrombosis, University Hospital Birmingham NHS Trust, Edgbaston, UK.
Wilde
J
J
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000517:prevention & control; D006488:Hemostasis, Surgical; D006489:Hemostatic Techniques; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D013511:Minor Surgical Procedures; D009067:Mouthwashes / Q000627:therapeutic use; D019647:Oral Surgical Procedures; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D014812:Vitamin K / Q000008:administration & dosage / Q000627:therapeutic use; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D009067:Mouthwashes; D014812:Vitamin K; D014859:Warfarin; D014148:Tranexamic Acid