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Stoner, S.C., Lea, J.W., Dubisar, B.M. and Farrar, C. (2003) Possible international normalized ratio elevation associated with celecoxib and warfarin in an elderly psychiatric patient. Journal of the American Geriatrics Society, 51, 728-729. doi:10.1034/j.1600-0579.2003.00228.x

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• TITLE: Patients with dental hemorrhagic complicationsundergoing warfarin therapy exhibit excessiveinternational normalized ratio prolongation: A report of 2 cases

  AUTHORS: Tsuyoshi Sato, Yasuaki Sakata, Norimichi Nakamoto, Yousuke Fukushima, Aya Nakamoto, Yuichiro Enoki, Yoshie Sano, Shoichiro Kokabu, Tetsuya Yoda

  KEYWORDS: Warfarin Therapy; International Normalized Ratio; Hypoalbuminemia; Vitamin K Deficiency

  JOURNAL NAME: Open Journal of Stomatology, Vol.3 No.1, March 18, 2013

  ABSTRACT: Dentalhemorrhagiccomplications,includingpostoperativebleedingandtraumatichemorrhageasemergencycases,oftenoccurinpatientsundergoingoralanticoagulanttherapysuchaswarfarintherapy.Recentresearchrecommendsthatwarfarindosageshouldbeassessedevery12weeks.Therefore,mostphysiciansgenerallyacceptinternationalnormalizedratio(INR)monitoringatlongerintervals.However,casesareencounteredinwhichtheINRprolongationisobserveddespiteofinvariabledosageofwarfarin.Inthisreport,wepresent2casesofpatientswithdentalhemorrhagiccomplicationsundergoingoralanticoagulanttherapywhoexhibitedexcessiveINRprolongation.Thesepatientsexhibiteddecreasedappetiteandhypoalbuminemia. Wespeculatethatlong-termappetitelossresultedintheincreaseintheserumconcentrationoffreewarfarin andvitaminK deficiency. Ourstudyindicates that weshouldnotice malnourishmentwhenwetreat patientswhohaveundergonewarfarintherapy with dentalsurgical procedures.Itisrecommendedthat measurementofINR just beforeadentalsurgicaltreatment.