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for patients awaiting elective dental procedures who are taking warfarin for
a limited period (e.g. 6 months for a DVT) then the procedure should be postponed
until the warfarin has been stopped
- for patients on long-term warfarin treatment (e.g. atrial fibrillation,
recurrent venous thromboembolism, mechanical heart valves) then the UK Medicines
Information (UKMI) says that warfarin does not need to be stopped before primary
dental procedures (although the continuation of warfarin treatment increases
the risk of bleeding, the risk appears to be minimal)
- an INR should be measured within 24 hours of undertaking the procedure
- the UKMI recommend that no individual should have an dental procedure in
primary care if an INR > 4.0 - however British Haematological Society guidelines
recommend that the INR should be no greater than two at the time of the procedure
(2)
- UKMI also recommend that warfarin patients with renal or hepatic disease
or those on chemotherapy or cytotoxics should have dental procedures in hospital
Reference:
- Pulse (2004), 64 (7), 83.
- MeReC Bulletin (1997), 8(1), 1-4.
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