NEWER CONCEPTS FOR THE  ANTICOAGULATED PATIENT'S CARE



There have been sea changes in the ways to treat patients who are anticoagulated in dental care scenarios.

The categories we come across are

- The warfarinised patient ( post DVT,PE AF, recent MI, structural heart valve disease or replacement)
- The less worrisome aspirin-clopidogrel-dipyridamol-afciximab treated patients.
                                                                
The newer protocols are:

- WARFARIN: 

Donot stop. 
Check INR within 72 hrs before. If below 4 proceed with MOS or quivalent procedures (provided patient has stable INR) with local measures(SURGICEL AND SUTURES). Expect bleeding and warn patient and manage accordingly rather than risk patient's life by stopping anticoagulation.


In case of major surgeries heparinise the patient and control anticoagulation during surgery and reverse if necessary and restart warfarin gradually overlapping heparin as the patient recovers and risks of surgical bleed is less.

- ORAL ANTICOAGULANTS:

ASPIRIN ALONE:  DONOT STOP . Manage using local measures.

ASPIRIN + CLOPIDOGREL:  Stop clopidogrel for 7 days .Leave patients on Aspirin. Liase with GP and proceed. 

ASPIRIN + DIPIRYDAMOL: DONOT STOP. CONTINUE AND PROCEED.

These are all recomendations from British Commitee of Standards for Haematology