[Protocol for adapting treatment with vitamin K antagonists before dental extraction].
BACKGROUND
The purpose of this study was to validate a protocol for dental extraction in patients taking vitamin K antagonists without changing the treatment when the INR is lower than 2.8.


METHODS
One hundred four extractions (96 patients) were performed during a 9 month period in patients taking vitamin K antagonists. Extraction was performed when the international normalized ratio (INR) was less than 2.8, otherwise, the treatment was modified until the desired INR was reached. Extractions were performed under para-apical and alveolar local anesthesia and sutured with hemostatic gauze.


RESULTS
Three patients developed postoperative bleeding requiring alveolar revision with local application of tranexamic acid and in one case use of a biological glue.


CONCLUSIONS
The following protocol can be proposed: ambulatory extraction under local anesthesia with an INR the day before extraction: the extraction is performed if the INR is<=2.8 using hemostatic gauze suture and tranexamic acid in case of persistent bleeding.
Garcia-Darennes
F
F
Service de Stomatologie de l'Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 28, rue du Doyen Lépine, 69500 Bron.
Darennes
J
J
Freidel
M
M
Breton
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D002985:Clinical Protocols; D017742:Dental Care for Chronically Ill / Q000379:methods*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control*; D010630:Phenindione / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D014081:Tooth Extraction; D014148:Tranexamic Acid / Q000627:therapeutic use; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014812:Vitamin K; D010630:Phenindione; D014859:Warfarin; D014148:Tranexamic Acid; C017673:fluindione