Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. There were no “major” complications in either group. One patient (3%) also required a “minor” intervention (repacking of extraction site). The 29 patients in the control group discontinued off of warfarin underwent a total of 99 procedures. One patient (3%) required “minor” intervention with removal of a “liver clot” on post-op day 2 with repacking and suturing.
#INR NORMAL RANGE FOR SURGERY SKIN#
Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, pre-prosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. Local measures including removal of granulation tissue, packing, suturing, etc. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and pre-prosthetic bone surgery, and incision and drainage. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. The control group (n = 29) was managed by discontinuing warfarin and any antiplatelet medication(s) prior to surgery. Patients and Methods: Sixtyone patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Keywords: Point-Of-Care In-Office INR International Normalized Ratio Thromboembolism Perioperative Care Anticoagulated Oral and Maxillofacial Surgery Extraction Warfarin Coumadin Oral Surgery Hemostasis Local Hemostatic Measures Antithrombolytics Protocol Packing Suturing Received 11 March 2013 revised 12 April 2013 accepted This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Center for Facial, Oral & Implant Surgery, Good Shepherd Medical Center, Longview, USAĮmail: © 2013 Gregory P.
0 kommentar(er)
