The International Normalized Ratio as a measure of anticoagulation: Significance for the management of the dental outpatient

Susceptibility to bleeding in the patient treated with coumarin derivatives poses difficult management issues for the dentist. Classic monitoring for anticoagulation relied on the prothrombin time, but reagent variability issues have caused the emergence of the International Normalized Ratio (INR) as an alternative, and possibly more reliable, laboratory test for the assessment of a patient's anticoagulation status. The literature suggests that an INR range of 1.5 to 2.5 represents the most appropriate level of anticoagulation for the surgical patient. That is, at this INR, some protection is afforded against thrombo-embolic events without significantly sacrificing effective post-operative hemostasis. Since the patient with an INR value within the recommended range is still anticoagulated, he/she is still at risk for post-operative bleeding. Adherence to local hemostatic measures--such as pressure, topical thrombin, alveolar-placed resorbable sponges, and primary wound closure--offers the patient important adjunctive protection against post-operative bleeding.