Prolonged Bleeding Flashcards
What is target (therapeutic) INR?
2.0-4.0
Do they stop the Warfarin 1 day before?
i. No – Therapeutic range
ii. Half-life of warfarin is approx. 48 hours
iii. Risks of stopping warfarin outweigh risks of prolonged
bleeding
iv. Takes around 2 days for the changes in the oral dose of
warfarin to affect the INR
v. In the therapeutic range – no significant risk of post-operative
bleeding demonstrated
What steps will be taken to ensure no prolonged bleeding?
i. INR checked <24 hours before the extraction
ii. OK to proceed if <4
iii. Dissolvable/Resorbable sutures after extraction
iv. Surgicel placed into socket
v. Post-operative instructions issued with contact numbers if prolonged bleeding occurs
vii. Gauze to take home if bleeding occurs to bite down on
what is the INR in health?
1.0
What does a higher INR tell you?
- the greater the degree of anti-coagulation
- Risk of adverse side effects (including prolonged bleeding).
What can you ask a patient to identify unknown bleeding problems?
Have you ever had any problems in the past with stopping bleeding after cutting yourself, after dental care or following operations?’;
What can you ask a pt who has had an incidence of prolonged bleeding?
- When did the prolonged bleeding occur?;
- On how many occasions?;
- Have there been problems since or before the episode?;
- Were there any local factors that might have contributed to the prolonged bleeding (e.g. local infection or local soft tissue trauma)?
- How was the situation managed?;
- Were any investigations or special tests undertaken and what were the results of these?
why should aspirin not be stopped before dental treatment?
There is NO POINT in stopping aspirin before dental treatment likely to result in bleeding because it takes weeks for the effect to be reversed and the risk of further thrombotic events in the patient is not worth it - better to carry on with necessary treatment and utilise good haemostatic techniques
