Key result
Two elderly female patients on stable warfarin doses exhibited excessive INR prolongation and dental hemorrhagic complications, likely due to increased free warfarin and vitamin K deficiency from long-term appetite loss and hypoalbuminemia.
Case Report (n=2)
No
Malnourishment and hypoalbuminemia due to decreased appetite can lead to excessive INR prolongation in elderly patients on stable warfarin doses, highlighting the need for INR monitoring before dental surgery.
May suggest INR monitoring in malnourished elderly warfarin patients before dental procedures; hypothesis-generating case reports leave need for prospective confirmation open.
Dental hemorrhagic complications, including postoperative bleeding and traumatic hemorrhage as emergency cases, often occur in patients undergoing oral anticoagulant therapy such as warfarin therapy. Recent research recommends that warfarin dosage should be assessed every 12 weeks. Therefore, most physicians generally accept international normalized ratio (INR) monitoring at longer intervals. However, cases are encountered in which the INR prolongation is observed despite of invariable dosage of warfarin. In this report, we present 2 cases of patients with dental hemorrhagic complications undergoing oral anticoagulant therapy who exhibited excessive INR prolongation. These patients exhibited decreased appetite and hypoalbuminemia. We speculate that long-term appetite loss resulted in the increase in the serum concentration of free warfarin and vitamin K deficiency. Our study indicates that we should notice malnourishment when we treat patients who have undergone warfarin therapy with dental surgical procedures. It is recommended that measurement of INR just before a dental surgical treatment.
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Sato et al. (2013) conducted a case report in Dental hemorrhagic complications with excessive INR prolongation (n=2). Warfarin therapy with concurrent malnourishment/hypoalbuminemia was evaluated on Excessive INR prolongation. Two elderly female patients on stable warfarin doses exhibited excessive INR prolongation and dental hemorrhagic complications, likely due to increased free warfarin and vitamin K deficiency from long-term appetite loss and hypoalbuminemia.
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