Management of heparin therapy in the high-risk, chronically anticoagulated, oral surgery patient: A review and a proposed nomogram

Purpose: This study analyzes the use of a standard nomogram that can help r educe the level of anticoagulation preoperatively to effectively manage per ioperative heparin therapy in chronically anticoagulated oral surgery patie nts who are at high risk for thromboembolism. Patients and Methods: Twenty patients with significant cardiovascular disea se, ranging in age from 56 to 79 years and requiring oral surgery, were ran domly divided into 2 groups. All patients were on chronic warfarin therapy, and perioperative heparinization was recommended by their cardiologist. Gr oup A (n = 10) had their anticoagulation therapy managed with the use of a standard nomogram. The heparin therapy for group B (n = 10) was managed wit hout the use of the nomogram. The records of all patients were analyzed for therapeutic efficacy of heparinization, number of laboratory tests require d, duration of hospitalization, and complications related to heparinization . Results: Patients in group A did significantly better in all parameters whe n compared with group B patients. There were no complications in group A, w hereas there was a 20% incidence of complications related to anticoagulatio n therapy in group B. Conclusions: The use of a standard nomogram to manage anticoagulation thera py in the oral surgery patient requiring heparinization is strongly recomme nded. This provides optimal therapeutic benefit, decreases the incidence of complications, and makes the hospitalization less costly and more comforta ble for the patient.