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CC BY-NC-ND 4.0 · Eur J Dent 2014; 08(04): 475-480
DOI: 10.4103/1305-7456.143628
Original Article
Dental Investigation Society

Correlation between International Normalized Ratio values and sufficiency of two different local hemostatic measures in anticoagulated patients

Mohamed Zaghlool Amer
1   Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
,
Samah I. Mourad
1   Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
,
Ahmed S. Salem
1   Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
2   OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium
,
Ehab Abdelfadil
1   Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)

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ABSTRACT

Objectives: The management of patients receiving oral anticoagulant therapy (OAT) undergoing minor oral surgeries is controversial. This study was designed to evaluate the correlation between International Normalized Ratio (INR) values and the sufficiency of two different local hemostatic measures in controlling postextraction bleeding in anticoagulated patients. Materials and Methods: One hundred and sixty patients receiving Warfarin OAT were included in this study. Patients were selected so that 80 patients have INR values of ≤2, whereas the remaining patients have the INR values ranging from 2 to 3. Forty patients were then randomly selected from each category to form two equal groups. Forty-five patients who had never been on OAT were selected as a negative control group (group 1). Failure to achieve hemostasis using a pressure pack was managed using either tranexamic acid (group 2) or Ankaferd Blood Stopper (ABS) (group 3). Results: The INR values of patients included in group 2 and 3 ranged from 1.5 to 3, with a mean of 2.2. No significant difference was recorded between the use of either tranexamic acid or ABS in achieving hemostasis in anticoagulated patients with INR values ranging between 2 and 3 (P = 0.93). Conclusion: Based on our findings, ABS is a hemostatic agent of good efficacy. The effect of ABS in controlling post-extraction bleeding in anticoagulated patients with INR values ≤3 is comparable to tranexamic acid with no evidence to support the superiority of tranexamic acid over ABS.

Key words:

Gel foam - postextraction bleeding - tranexamic acid - warfarin - ankaferd
 

  • REFERENCES

  • 1 Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med 1998; 158: 1610-6
    CrossrefPubMedGoogle Scholar
  • 2 Ramström G, Sindet-Pedersen S, Hall G, Blombäck M, Alander U. Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 1993; 51: 1211-6
    CrossrefPubMedGoogle Scholar
  • 3 Souto JC, Oliver A, Zuazu-Jausoro I, Vives A, Fontcuberta J. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: A prospective randomized study. J Oral Maxillofac Surg 1996; 54: 27-32
    CrossrefPubMedGoogle Scholar
  • 4 Sindet-Pedersen S, Ramström G, Bernvil S, Blombäck M. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med 1989; 320: 840-3
    CrossrefPubMedGoogle Scholar
  • 5 Zusman SP, Lustig JP, Baston I. Postextraction hemostasis in patients on anticoagulant therapy: The use of a fibrin sealant. Quintessence Int 1992; 23: 713-6
    PubMedGoogle Scholar
  • 6 Brimble KS, Ingram AJ, Eikelboom JW, Hart RG. Anticoagulants in patients with atrial fibrillation and end-stage renal disease. Postgrad Med 2012; 124: 17-25
    CrossrefPubMedGoogle Scholar
  • 7 Jacomella V, Corti N, Husmann M. Novel anticoagulants in the therapy of peripheral arterial and coronary artery disease. Curr Opin Pharmacol 2013; 13: 294-300
    CrossrefPubMedGoogle Scholar
  • 8 Conway EM, Bauer KA, Barzegar S, Rosenberg RD. Suppression of hemostatic system activation by oral anticoagulants in the blood of patients with thrombotic diatheses. J Clin Invest 1987; 80: 1535-44
    CrossrefPubMedGoogle Scholar
  • 9 Ferrieri GB, Castiglioni S, Carmagnola D, Cargnel M, Strohmenger L, Abati S. Oral surgery in patients on anticoagulant treatment without therapy interruption. J Oral Maxillofac Surg 2007; 65: 1149-54
    CrossrefPubMedGoogle Scholar
  • 10 Sacco R, Sacco M, Carpenedo M, Mannucci PM. Oral surgery in patients on oral anticoagulant therapy: A randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: e18-21
    PubMedGoogle Scholar
  • 11 Walker CP, Royston D. Thrombin generation and its inhibition: A review of the scientific basis and mechanism of action of anticoagulant therapies. Br J Anaesth 2002; 88: 848-63
    CrossrefPubMedGoogle Scholar
  • 12 Petersen JK, Krogsgaard J, Nielsen KM, Nørgaard EB. A comparison between 2 absorbable hemostatic agents: Gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel). Int J Oral Surg 1984; 13: 406-10
    CrossrefPubMedGoogle Scholar
  • 13 Bacci C, Maglione M, Favero L, Perini A, Di Lenarda R, Berengo M. et al. Management of dental extraction in patients undergoing anticoagulant treatment. Results from a large, multicentre, prospective, case-control study. Thromb Haemost 2010; 104: 972-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Thosar N, Basak S, Bahadure RN, Rajurkar M. Antimicrobial efficacy of five essential oils against oral pathogens: An in vitro study. Eur J Dent 2013; 7: S71-7
    Google Scholar
  • 15 Mistry KS, Sanghvi Z, Parmar G, Shah S. The antimicrobial activity of Azadirachta indica, Mimusops elengi, Tinospora cardifolia, Ocimum sanctum and 2% chlorhexidine gluconate on common endodontic pathogens: An in vitro study. Eur J Dent 2014; 8: 172-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U, Ozturk Y. et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008; 36: 163-70
    Google Scholar
  • 17 Isler SC, Demircan S, Cakarer S, Cebi Z, Keskin C, Soluk M. et al. Effects of folk medicinal plant extract Ankaferd Blood Stopper on early bone healing. J Appl Oral Sci 2010; 18: 409-14
    CrossrefPubMedGoogle Scholar
  • 18 Yaman E, Görken F, Pinar ErdemA, Sepet E, Aytepe Z. Effects of folk medicinal plant extract Ankaferd Blood Stopper(®) in vital primary molar pulpotomy. Eur Arch Paediatr Dent 2012; 13: 197-202
    CrossrefPubMedGoogle Scholar
  • 19 Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M. et al. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 2008; 139 Suppl: 3S-24
    CrossrefPubMedGoogle Scholar
  • 20 Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease. Br Dent J 2003; 195: 439-45
    CrossrefPubMedGoogle Scholar
  • 21 Venkateshwar GP, Padhye MN, Khosla AR, Kakkar ST. Complications of exodontia: A retrospective study. Indian J Dent Res 2011; 22: 633-8
    CrossrefPubMedGoogle Scholar
  • 22 Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T. Dental extractions in patients maintained on continued oral anticoagulant: Comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88: 137-40
    CrossrefPubMedGoogle Scholar
  • 23 Guidelines on oral anticoagulation: Third edition. Br J Haematol 1998; 101: 374-87
    CrossrefPubMedGoogle Scholar
  • 24 Devani P, Lavery KM, Howell CJ. Dental extractions in patients on warfarin: Is alteration of anticoagulant regime necessary?. Br J Oral Maxillofac Surg 1998; 36: 107-11
    CrossrefPubMedGoogle Scholar
  • 25 Mulligan R, Weitzel KG. Pretreatment management of the patient receiving anticoagulant drugs. J Am Dent Assoc 1988; 117: 479-83
    CrossrefPubMedGoogle Scholar
  • 26 Bernardoni-Socorro C, Arteaga-Vizcaino M, Villamizar Y, Diez-Ewald M, Vizcaíno-Salazar G, Torres-Guerra E. et al. Mouth-washing with tranexamic acid in patients treated with oral anticoagulants subjected to oral surgery procedures. Invest Clin 1998; 39: 77-83
    PubMedGoogle Scholar
  • 27 Bodner L, Weinstein JM, Baumgarten AK. Efficacy of fibrin sealant in patients on various levels of oral anticoagulant undergoing oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86: 421-4
    CrossrefPubMedGoogle Scholar
  • 28 Rakocz M, Mazar A, Varon D, Spierer S, Blinder D, Martinowitz U. Dental extractions in patients with bleeding disorders. The use of fibrin glue. Oral Surg Oral Med Oral Pathol 1993; 75: 280-2
    CrossrefPubMedGoogle Scholar
  • 29 Blinder D, Martinowitz U, Ardekian L, Peleg M, Taicher S. Oral surgical procedures during anticoagulant therapy. Harefuah 1996; 130: 681-3 727
    PubMedGoogle Scholar
  • 30 Morimoto Y, Niwa H, Minematsu K. Risk factors affecting postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. J Oral Maxillofac Surg 2011; 69: 1550-6
    CrossrefPubMedGoogle Scholar
  • 31 Zanon E, Martinelli F, Bacci C, Cordioli G, Girolami A. Safety of dental extraction among consecutive patients on oral anticoagulant treatment managed using a specific dental management protocol. Blood Coagul Fibrinolysis 2003; 14: 27-30
    CrossrefPubMedGoogle Scholar
  • 32 Salam S, Yusuf H, Milosevic A. Bleeding after dental extractions in patients taking warfarin. Br J Oral Maxillofac Surg 2007; 45: 463-6
    CrossrefPubMedGoogle Scholar
  • 33 Adachihara A. Oral treatment of hemophilia A using traditional kanpo medicine, Huang-lien-chieh-tu-tang (plant extract). Haemostasis 1983; 13: 78-82
    PubMedGoogle Scholar
  • 34 Gao J, Hooker BS, Anderson DB. Expression of functional human coagulation factor XIII A-domain in plant cell suspensions and whole plants. Protein Expr Purif 2004; 37: 89-96
    CrossrefPubMedGoogle Scholar
  • 35 Cipil HS, Kosar A, Kaya A, Uz B, Haznedaroglu IC, Goker H. et al. In vivo hemostatic effect of the medicinal plant extract Ankaferd Blood Stopper in rats pretreated with warfarin. Clin Appl Thromb Hemost 2009; 15: 270-6
    CrossrefPubMedGoogle Scholar
  • 36 Tasdelen FisginN, Tanriverdi CayciY, Coban AY, Ozatli D, Tanyel E, Durupinar B. et al. Antimicrobial activity of plant extract Ankaferd Blood Stopper. Fitoterapia 2009; 80: 48-50
    CrossrefPubMedGoogle Scholar