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Abdelhafiz, A.H., Myint, M.P., Tayek, J.A. and Wheeldon, N.M. (2009) Anemia, hypoalbuminemia, and renal impairment as predictors of bleeding complications in patients receiving anticoagulation therapy for nonvalvular atrial fibrillation: A secondary analysis. Clinical Therapeutics, 31, 1534-1539. doi:10.1016/j.clinthera.2009.07.015

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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.