![]() Mulligan and Weitzel (1988) considered the range of safety to lie between 1.5 and 2.0 times the control PT. Johnson and Leary adjusted the anticoagulant dose to allow for a PT 1.5 times that of the control. According to Spouge, an optimal balance is obtained when the prothrombin time (PT) is 50% above normal. The level should be sufficient for achieving immediate hemostasis following the intervention and at the same time, limit the risk for thromboembolic events. Ī third philosophy is characterized by partial correction of the coagulation activity. However, the fear of possible hemorrhagic complications increases stress in the cardiac patient, and this induces the release of substances that promote fibrinolytic activity. , Leaving the anticoagulant dose unaltered is a simple technique, and development of thromboembolic events is prevented. Second group of study has reported on tooth extractions in patients taking coumarin derivatives without the occurrence of severe bleeding episodes. , According to these authors, the small but potentially hazardous effect of discontinuing anticoagulant therapy is not justified in patients anticoagulated within the therapeutic range. They state that dental extractions are possible at therapeutic anticoagulation levels. ![]() A first group of authors recommends leaving the anticoagulant dose unaltered. Three different treatment philosophies can be distinguished. ![]() Some authors recommend the withdrawal of OAT for several days or prescribe heparin before the dental procedure. In fact, three decades of research on this issue have produced conflicting results. The proper approach to dental extractions in patients on oral anticoagulant therapy (OAT) remains a matter of debate focused on the balance between the risk of thromboembolic events and bleeding complications. Evaluation of hemorrhage immediately after extraction and postextraction in patients on oral anticoagulant therapy for last 5 years. How to cite this URL: Kumar D, Ahmad T, Bhat TA, Khadase P, Kaur A. How to cite this article: Kumar D, Ahmad T, Bhat TA, Khadase P, Kaur A. Keywords: Anticoagulants, extraction, international normalized ratio, warfarin Its also concluded that patients on anticoagulant are at high risk of thromboembolic events than postextraction hemorrhage so anticoagulant therapy should be continued without any alteration. Conclusion: We conclude that hemorrhagic episodes postextraction in patients on anti-coagulant therapy is manageable following atraumatic extraction, hemostatic agents and sutures. One patient from the study group (50-year-old female, INR 3.2) had intermittent oozing on the 3 rd day postoperatively, after extractions of lower right 2 nd molar. Results: None of the patients, in study group, had any immediate postoperative bleeding during the 30 min that they were observed after the extractions, and no patient in study group had any bleeding during the first 24 h. Any patients with INR outside the therapeutic range, patients with liver disease, patients on other drugs that affect the hemostasis (long-term use of nonsteroidal anti-inflammatory drug, chemotherapeutic and immunosuppressant drugs), and patients who refused to sign the consent for the study were excluded from the study. Before undertaking any procedure, the international normalized ratio (INR) for each of the patient under study was requested and the study was only performed if INR was within the therapeutic range of 2.0–4.0 for each patient. Materials and Methods: A total of 100 patients, equally divided into study group and control group of 50 patients each, who were on anticoagulant therapy for the past 5 years were included in the study and were assessed for general medical status, drug dosage, indication for anticoagulant therapy, and duration of treatment before being included in the study. Aim and Objective: The aim of our study was to evaluate hemorrhage immediately after extraction and postextraction in patients on oral anticoagulant therapy for the past 5 years.
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