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Comparison of uninterrupted warfarin and bridging therapy using lowmolecular weight heparin with respect to the severity of bleeding after dental extractions in patients with prosthetic valves [Anatol J Cardiol]
Anatol J Cardiol. 2016; 16(7): 467-473 | DOI: 10.5152/AnatolJCardiol.2015.6130  

Comparison of uninterrupted warfarin and bridging therapy using lowmolecular weight heparin with respect to the severity of bleeding after dental extractions in patients with prosthetic valves

İsmail Erden1, Emine Çakcak Erden1, Tolga Aksu1, Şükriye Ebru Gölcük1, Burak Turan1, Ayhan Erkol1, Mustafa Akçakoyun2, Tülin Sayın3
1Department Of Cardiology, Kocaeli Derince Training And Research Hospital; Kocaeli -turkey
2Departments Of Cardiology, Koşuyolu Education And Research Hospital; İstanbul -turkey
3Dentistry, Koşuyolu Education And Research Hospital; İstanbul -turkey

Objective: The management of anticoagulated patients with warfarin during dental extraction is an intricate issue. We carefully designed the current study so that the amount of bleeding was measured with objective methods and the data from the same patient in different dental extraction appointments could be compared, eliminating the bleeding diathesis differences of patients.
Methods: This prospective and controlled study was conducted in 36 adult patients with prosthetic valve requiring multiple tooth extractions. The first dental extraction was performed without the discontinuation of warfarin therapy, and the second procedure was performed with a discontinuation of warfarin and bridging with low-molecular weight heparin (LMWH). The two dental extraction protocols in the same patient group were compared. The total amount of bleeding was calculated as the difference between the weights of gauze swabs used before and after the tamponade; the number of gauze swabs used for bleeding control in the first 48 h was recorded.
Result: The median number of used gauze swabs was 2.5 (IQR: 1–5) and 3.0 (IQR: 2–7) in the first and second dental extraction procedures, respectively. The median bleeding time was 50.0 (IQR: 20–100) in the first procedure compared with 60.0 (IQR: 40–140) min in the second procedure. The mean amounts of bleeding were 2194±1418 mg in the first dental extraction procedure and 2950±1694 mg in the second dental extraction procedure. The median number of used gauze swabs, the median bleeding time, and the mean amount of bleeding were statistically higher in the second dental extraction procedure (p<0.001).
Conclusion: Continued warfarin treatment at the time of dental extractions reduces the total amount of bleeding compared with bridging therapy in patients with prosthetic valves. (Anatol J Cardiol 2016; 16: 467-73)

Keywords: dental extraction, prosthetic valve, bridging therapy


İsmail Erden, Emine Çakcak Erden, Tolga Aksu, Şükriye Ebru Gölcük, Burak Turan, Ayhan Erkol, Mustafa Akçakoyun, Tülin Sayın. Comparison of uninterrupted warfarin and bridging therapy using lowmolecular weight heparin with respect to the severity of bleeding after dental extractions in patients with prosthetic valves. Anatol J Cardiol. 2016; 16(7): 467-473

Corresponding Author: İsmail Erden, Türkiye


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