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Anticoagulant therapy

On 5/28/10 4:21 AM, "Ken Serota" wrote: > SINGLE FIXTURE PLACEMENT - do you need to discontinue anticoagulant > therapy??? > > kendo From Osseo News Nicholas Toscano DDS MS December 17th, 2007 In my opinion below are some helpful go-bys in the Dental management of the anticoagulated patient. REMEMBER TO ALWAYS CONSULT WITH THE PATIENTS PHYSCIAN PRIOR TO ALTERING ANY PRESCRIBED MEDS: Management is dependent on the type of procedure being performed, lab test results and type of medication the patient is taking. Aspirin or Plavix® therapy can be discontinued 7 days prior to surgery which should result in better hemostasis. These drugs can then be restarted safely 48 to 72 hours post-operatively. For patients taking Coumadin®, proper lab tests should be done and a consult to the physician may be required depending on lab results, medical condition, type of surgery being performed and the possible need for drug dosage reduction. Studies have shown that extractions can be done in patients with an INR of 2.5 to 3.5 safely, however the higher the INR, the more the need for hemostatic measures. Jeske found that the literature does not support the routine withdrawal of anticoaugulation therapy. Dentists should be prepared for bleeding that exceeds normal and may have to provide hemostatic measures. Giglio suggested that single tooth extractions or minimally invasive procedures such as crown lengthening where minimal bleeding is expected, are indicated if the INR is less then 4. In procedures where moderate bleeding is expected, such as block or gingival grafts, an INR of less then 3 is necessary. Little and Falace¹s review of the literature, recommends that surgery may be performed with an INR of 2.0 to 3.0. For INR values of 3.0 to 3.5, it is recommended that the dosage of anticoagulant be altered depending on bleeding expected during the surgical procedure. Surgery should be delayed for values of 3.5 until the INR is within the therapeutic range of 2.0 to 3.5. Key labs tests to know: The platelet count provides a quantitative evaluation of platelet function. A normal platelet count should be 100,000 to 400,000 cells/mm3. A platelet count of less than 100,000 cells/mm3 is called thrombocytopenia and often can be associated with major postoperative bleeding. The average lifespan of a platelet ranges from 7-12 days. The bleeding time provides an assessment of adequacy of platelet count and function. The test measures how long it takes a standardized skin incision to stop bleeding by the formation of a temporary hemostatic plug. The normal range of bleeding time depends on the way the test is performed, but is usually between 1 and 6 minutes. The bleeding time is prolonged in patients with platelet abnormalities or taking medications which affect platelet function. This test assesses platelet function. The prothrombin time (PT) measures the effectiveness of the extrinsic pathway to mediate fibrin clot formation. It is performed by measuring the time it takes to form a clot when calcium and tissue factor are added to plasma. A normal prothrombin time indicates normal levels of Factor VII and those factors common to both the intrinsic and extrinsic pathways (V, X, prothrombin, and fibrinogen). A normal prothrombin time is usually between 10 and 15 seconds. Prothrombin time is most often used by physicians to monitor oral anticoagulant therapy such as warfarin. The partial thromboplastin time (PTT) measures the effectiveness of the intrinsic pathway to mediate fibrin clot formation. It tests for all factors except for Factor VII. The test is performed by measuring the time it takes to form a clot after the addition of kaolin, a surface activating factor, and cephalin, a substitute for platelet factor, to the patient¹s plasma. A normal partial thromboplastin time is usually 25 to 35 seconds. Partial thromboplastin time is most often used by physicians to monitor heparin therapy. The INR was designed for patients on chronic anticoagulant therapy. It allows comparisons from one hospital to another. A patient with normal coagulation parameters has an INR of 1.0. The therapeutic range for a patient on anticoagulant therapy is between 2.0 and 3.5.

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