Documentation of various approaches and outcomes in patients on warfarin undergoing dental procedures: a review article.
Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population. This was a cohort study. Patient records were used to collect data on peri-procedural management of patients on warfarin, continuation or interruption of warfarin therapy, as well as bleeding and thromboembolic complications. Fifty medical records were reviewed from March to October 2012. Regarding management, 10% had no proper documentation, 74% underwent bridging therapy, 12% discontinued warfarin therapy, and 4% continued warfarin. Of the patients, 31% had minor bleeding (15% in patients on bridging therapy and 16% in patients continuing warfarin). Thromboembolic complications were documented in 4%, (2% in those on bridging therapy and 2% in those discontinuing warfarin). Patients on bridging therapy (heparin) were admitted to the hospital for a mean of five days, and none of the other patients were admitted. Adopting the protocol to continue warfarin caused bleeding tendency that was controlled with the usual measures, with more cost effectiveness, and no thromboembolic risks.
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Fayez El
FE
Shaer
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Ismael
I
Raslan
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Nora Al
NA
Osaimi
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Ghada
G
Bawazeer
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Fhakr
F
Alayobi
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Tarek
T
Alhogbani
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Suliman
S
Kharabsheh
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University Riyadh, Saudi Arabia.
Walid Al
WA
Habeeb
Dental procedures; bridging therapy; complications; heparin; warfarin
J Am Dent Assoc. 2000 Jan;131(1):77-81
10649877
Mayo Clin Proc. 2003 Nov;78(11):1392-6
14601698
Clin Sci (Lond). 1995 Sep;89(3):205-14
7493413
N Engl J Med. 1997 Jan 23;336(4):251-7
8995087
Br J Haematol. 2003 Nov;123(4):676-82
14616972
Br J Haematol. 1996 Feb;92(2):479-85
8603020
Ann Plast Surg. 2009 Mar;62(3):275-7
19240524
Circulation. 2012 Jul 24;126(4):486-90
22825410
Br Dent J. 2007 Oct 13;203(7):E15; discussion 410-1
17694045
Eur Heart J. 2007 Apr;28(7):880-913
17426080
Blood. 2012 Oct 11;120(15):2954-62
22932800
Oral Surg Oral Med Oral Pathol. 1986 Aug;62(2):149-51
2944052
Ann Pharmacother. 2006 Dec;40(12):2205-10
17090725
Br J Oral Maxillofac Surg. 2000 Apr;38(2):124-6
10864707
Chest. 2012 Feb;141(2 Suppl):e576S-600S
22315272
Chest. 2001 Jan;119(1 Suppl):108S-121S
11157645
Dermatol Surg. 2004 Aug;30(8):1091-4; discussion 1094
15274698
Prog Cardiovasc Dis. 1994 May-Jun;36(6):439-46
8184097
Am J Med. 2010 Feb;123(2):141-50
20103023
Arch Intern Med. 1998 Aug 10-24;158(15):1610-6
9701094
Arch Intern Med. 2003 Apr 28;163(8):901-8
12719198
Blood. 1991 Nov 1;78(9):2337-43
1657248
Circulation. 2004 Sep 21;110(12):1658-63
15364803
Ann Intern Med. 1995 Jan 1;122(1):40-2
7985894
Thromb Haemost. 2012 Aug;108(2):210-2
22688559
Lancet. 1994 Apr 9;343(8902):886-9
7908358
Lancet. 1993 Jan 30;341(8840):259-65
8093915
J Oral Maxillofac Surg. 1998 Aug;56(8):914-7; discussion 917-8
9710183
Lancet. 1996 Sep 7;348(9028):633-8
8782752
J Am Acad Dermatol. 2003 Feb;48(2):233-7
12582394
Circulation. 1995 Jul 15;92 (2):160-3
7600646
Blood. 2011 May 12;117(19):5044-9
21415266
Blood Coagul Fibrinolysis. 1992 Feb;3(1):25-31
1623117
N Engl J Med. 1997 May 22;336(21):1506-11
9154771
Chest. 2004 May;125(5):1642-50
15136371
J Oral Maxillofac Surg. 1996 Jan;54(1):27-32; discussion 323
8530996
Lancet. 1964 Jul 11;2(7350):62-4
14158680
N Engl J Med. 1989 Mar 30;320(13):840-3
2648144
J Oral Maxillofac Surg. 2007 Jun;65(6):1149-54
17517299
Br Dent J. 2007 Oct 13;203(7):389-93
17934422
Chest. 2012 Feb;141(2 Suppl):e326S-50S
22315266
Cleve Clin J Med. 2009 Nov;76 Suppl 4:S37-44
19880835
Thromb Haemost. 1994 Aug;72(2):222-6
7831656
Thromb Haemost. 2012 Aug;108(2):213-6
22688503
Am J Cardiol. 1999 Aug 15;84(4):478-80, A10
10468095
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jul;94(1):57-64
12193895