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Oral Surgery and Anticoagulants!
The 3 Most Common Anticoagulants
Not a day goes by where we don’t see patients who are
It is almost a daily occurrence where we are
taking an anticoagulant for some medical reason or
another. The most common ones we see in our practice
relatives and dental colleagues about the (and we’re betting yours too) are Warfarin
(Coumadin), management of anticoagulants and oral Aspirin (Bayer)
, and Clopidogrel
surgery. In our newsletter this month, we
How These Medicines Work
want to provide real, to the point answers to
help debunk the myths and clarify the facts
(Coumadin) works to inhibit the vitamin K
dependent clotting factors. If you think back to physiology
about common anticoagulants as it pertains
and pharmacology, these are Factors II, VII, IX, X and
Protein C and Protein S. This is also known as the
‘extrinsic’ clotting pathway. Aspirin
(Bayer) irreversibly blocks cyclooxygenase
function, inhibiting platelet aggregation for their 7-10 day
life span. This prolongs bleeding time in the patient. Most
patients are on a low dose of Aspirin (81mg), however
some patients who are higher risk for cardiovascular events
are on a full (325mg) dose. Clopidogrel
(Plavix) works also by inhibiting platelets.
This too, is given for its cardiovascular protective effects
If we can be of any assistance in helping manage
and has been shown to be more effective in patients with
any of your patients please don’t hesitate to call
Why Are So Many Patients on These
Patients are placed on anticoagulants for their cardioprotective
effects. Patients with Atrial Fibrillation, Coronary Artery
Disease, Artifical Heart Valves, History of DVT/PE are all at
risk of developing significant thrombolic events that can lead to
strokes, MI’s and PE’s.
Testing: INR (International Normalized Ratio): This tests the coagulation status of patients, and is the gold standard for measuring Coumadin effectiveness. It is derived from the Prothrombin Time (PT). Someone without a coagulation problem would have a value of 1.0 Most patients on Coumadin are ‘therapeutic’ at an INR between 2.0 and 3.0. The exception here is artificial valve patients who are usually maintained between 2.5 and 3.5.
Be mindful of these patients as almost all of them represent
patients with a significant underlying cardiovascular risk!
patient who has an INR less than morbid than a thromboembolic
to have an INR done prior to Coumadin dosing. There can be prescribing physician if you are
surgery. They are asked to significant risk in taking a patient going to alter a patient’s
phone our office at least the day off of their Coumadin. Generally, Coumadin schedule. It is the
before surgery with their current minor surgical bleeding is far less standard of care to have a
will be delayed for
There can be
Patients who have an
significant risk in
INR over 3.0
taking a patient off of
will be delayed for
We realize that each patient and each situation is different
In our office, patients on Aspirin and/or Plavix are told to maintain their normal routine. Surgical management of these patients includes local hemostatic measures such as oversewing, resorbable gelatin sponges and topical thrombin when
necessary. Occasionally electrocautery can be used to manage persistent oozing, however this is pretty rare. On all of these patients, we make sure that bleeding is well controlled prior to discharging our patient home. Our patients routinely leave with ample gauze for biting pressure and detailed written instructions.
As Always, if we can be of any service to you or
your patients, please don’t hesitate to call on us.
The Doctors and Staff at Falls Oral Surgery
Take a tour of our website!
View previous newsletters, educational videos, and
visual presentations about procedures we provide.
ROAN Regionaal Onderwijs Assistenten Neurologie HET DOPAMINERGE SYSTEEM Woensdag 17 april 2013 Programma 12.30 uur 13.00–14.00 uur BLOK 1: Casusbespreking 14.00-15.00 uur BLOK 2: Bespreking artikel NEJM 15.00 15.30-16.30 uur BLOK 3: Voorbeelden dystonie bij kinderen 16.30 uur Toelichting Zie bijlage. Sprekers Prof.dr. M.A. (Michèl) Willemsen, neuroloog U
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