WARFARIN

DO YOU CHANGE THE INR

INR BELOW 4.0

SHOULD DENTIST ADVISE ON CHANGE OF WARFARIN

1% of patients who have there warfarin changed had a serious embolic episode
Whal

STOPPING WARFARIN

BLEEDING RISK WITH EXTRACTION

• No anticoagulant 1%
• A/C delayed bleeding 9%
• Serious bleed 3%

Continuing warfarin led to ....... No deaths !

Whal

POST OP BLEEDING

REDUCTION OF BLEEDING

• oxidised cellulose (‘Surgicel’) or collagen sponges
• sutures
• 5% tranexamicacid four times a day for 2 days

Thromboembolic episode vs bleed

• About 33 people a day die due to heart attacks.
• Two men die for every woman who dies of a heart attack.
• About 60 people a day die due to strokes.
• About 37 people a day die due to heart failure.

TREATMENT OF STROKE

• tissue plasminogen activator (tPA)
• antiplatelet medication
• anticoagulants,
• intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia
• Solataire clot retrieval device

WHO SHOULD NOT BE TREATED ?

• Liver impairment/alcoholism
• Renal failure
• Haemophilia
• Cytotoxic medication

NORMAL INR 1.0

• Pulmonary embolus 2.0-3.0
• DVT 2.0-3.0
• Atrial fibrilation 2.0-3.0
• Recurrence of embolisim when warfarin stopped 2.0-3.0
• Recurrence of embolisim when taking warfarin 3.5-4.0

WHEN SHOULD INR BE MEASURED

DRUG INTERACTION

• Metronidazole
• Erthromycin
• Paracetamol
• Aspirin
• NSAIDS