Key result
Uninterrupted VKA during minor oral surgery leaves ~43% supratherapeutic without causing major bleeding.
Why the study?
Dental extractions can be safely performed on patients under VKAs therapy without stopping or changing dosage, but INR monitoring on the day of intervention is necessary to ensure adequate rates before surgery.
What is the rate of out-of-range INR values on the day of minor oral surgery in patients on uninterrupted vitamin K antagonists?
Observational (n=122)
What is the rate of out-of-range INR values on the day of minor oral surgery in patients on uninterrupted vitamin K antagonists?
A significant proportion of patients on VKAs present with out-of-range INR on the day of minor oral surgery, highlighting the importance of same-day testing to prevent potential bleeding complications.
Out-of-range INR is common before minor oral surgery on VKAs without major bleeding; leaves open whether routine monitoring improves safety.
INTRODUCTION: Dental extractions can be safely carried out on patients under vitamin K antagonists (VKAs) therapy, without stopping or changing the dosage, but the international normalized ratio (INR) needs to be monitored on the day of the intervention, showing adequate rates before proceeding. OBJECTIVES: This study aims at evaluating INR values, measured before oral surgery procedures, to assess the rate of patients, under VKAs therapy, outside the therapeutic range. MATERIALS AND METHODS: A clinical audit was carried out involving patients under VKAs, who needed minor oral surgery procedures, over a period of 18 months. The patient was instructed to not modify or suspend VKAs prior to the intervention. Before surgery, each patient fulfilled a questionnaire on dietary and oral hygiene habits, and a blood sample was collected for INR assessment (cut-off value for surgical procedure ≤3.5). RESULTS: One hundred twenty-two patients were enrolled: 69 (56.6%) had an INR value within the established therapeutic range, 53 (43.4%) were out of range. No intra- or postsurgical major bleeding was recorded. CONCLUSIONS: INR, measured on the same day of oral surgery, has the potential to prevent bleeding complications by the identification of those patients out of range, who may require adjusting the drug therapeutic dosage.
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Lombardi et al. (2020) conducted an observational in Patients receiving oral vitamin K antagonists undergoing oral surgery (n=122). Vitamin K antagonists (VKAs) therapy was evaluated on Rate of patients outside the therapeutic range (INR > 3.5). Among patients on vitamin K antagonists undergoing minor oral surgery without dosage modification, 43.4% had an INR value outside the therapeutic range, though no major bleeding was recorded.
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