Comparison of laboratory and immediate diagnosis of coagulation for patients under oral anticoagulation therapy before dental surgery.
BACKGROUND
Dental surgery can be carried out on patients under oral anticoagulation therapy by using haemostyptic measures. The aim of the study was a comparative analysis of coagulation by laboratory methods and immediate patient diagnosis on the day of the planned procedure.


METHODS
On the planned day of treatment, diagnoses were carried out on 298 patients for Prothrombin Time (PT), the International Normalised Ratio (INR), and Partial Thromboplastin Time (PTT). The decision to proceed with treatment was made with an INR < 4.0 according to laboratory results.


RESULTS
Planned treatment did not go ahead in 2.7% of cases. Postoperatively, 14.8% resulted in secondary bleeding, but were able to be treated as out-patients. 1.7% had to be treated as in-patients. The average error between the immediate diagnosis and the laboratory method: 95% confidence interval was -5.8 +/- 15.2% for PT, -2.7 +/- 17.9 s for PTT and 0.23 +/- 0.80 for INR. The limits for concordance were 9.4 and -21.1% for PT, 15.2 and -20.5 s for PTT, and 1.03 and -0.57 for INR.


CONCLUSIONS
This study showed a clinically acceptable concordance between laboratory and immediate diagnosis for INR. Concordance for PT and PTT did not meet clinical requirements. For patients under oral anticoagulation therapy, patient INR diagnosis enabled optimisation of the treatment procedure when planning dental surgery.
Kruse-Loesler
Birgit
B
Department of Cranio-Maxillofacial Surgery, University of Muenster, Muenster, Germany.
Kelker
Matthias
M
Kleinheinz
Johannes
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D001780:Blood Coagulation Tests / Q000379:methods*; D002648:Child; D016001:Confidence Intervals; D003661:Decision Support Techniques; D003814:Dentistry, Operative / Q000379:methods*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011292:Premedication; D011517:Prothrombin Time; D055815:Young Adult
D000925:Anticoagulants