Utility of an international normalized ratio testing device in a hospital-based dental practice.
OBJECTIVE
The authors aimed to evaluate the utility of an in-office international normalized ratio (INR) testing device in identifying patients with INR test values considered out of the normal range for dental procedures.


METHODS
This prospective cohort study involved use of an INR testing device to obtain INR test values in the dental office for patients thought to be at risk of experiencing bleeding complications after undergoing invasive dental procedures. The authors recorded demographic, social and medical history data, as well as clinical signs and symptoms of liver disease. The authors considered an INR out of range if it was greater than or equal to 1.4 for patients with potential liver disease and greater than 3.5 for patients receiving warfarin.


RESULTS
The authors completed an in-office INR test for 66 patients receiving warfarin whose INR had not been tested within the preceding 48 hours and 34 patients suspected of having liver disease. Eleven (17 percent) patients receiving warfarin and seven (21 percent) patients suspected of having liver disease had INR values considered out of range. Dental treatment was deferred for eight of 11 patients in the warfarin group who had INR values in the range of 3.6 to 7.4, while three others had dental procedures without bleeding complications. Six of seven patients who had documented or suspected liver disease and an out-of-range INR (range 1.5-2.5) underwent their dental procedures without experiencing bleeding complications.


CONCLUSIONS
Use of an in-office INR test indicated a high incidence of elevated INR values. The results of this study point to the importance of obtaining current INR values before performing invasive dental procedures for patients receiving warfarin therapy whose INR values have not been tested recently, and for patients thought to be at risk of developing or having liver disease.
Department of Oral Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, N.C. 28232, USA. Mike.Brennan@carolinas.org
Michael T
MT
Brennan
Catherine
C
Hong
Scott L
SL
Furney
Philip C
PC
Fox
Peter B
PB
Lockhart
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000097:blood / Q000627:therapeutic use; D000925:Anticoagulants / Q000097:blood / Q000627:therapeutic use; D015331:Cohort Studies; D017742:Dental Care for Chronically Ill; D003777:Dental Prophylaxis; D003796:Dental Service, Hospital; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000295:instrumentation*; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D014081:Tooth Extraction; D014859:Warfarin / Q000097:blood / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D014859:Warfarin