Simple and safe method to prepare patients with prosthetic heart valves for surgical dental procedures

Temporary discontinuation of high-intensity oral anticoagulant treatment is not recommended in patients under going dental surgery. This policy is not based on solid data from randomized clinical trials but on expert consensu s. The alternative, i.e., to continue treatment and treat patients with tra nexamic acid mouthwash, often is not applicable. A prospective cohort study was carried out to evaluate bleeding and thromboembolic complications in p atients bearing prosthetic heart valves and registering International Norma lized Ratio (INR) Values between 2.0 and 4.5, who underwent dental procedur es after a 2-day suspension of warfarin treatment. One hundred Four consecu tive patients receiving high-intensity anticoagulation underwent 123 dental procedures after 2 days' warfarin withdrawal No major bleeding complicatio ns occurred in the week after the procedure; minor bleeding requiring local measures occurred in two patients. No thromboembolic events and no cases o f bacterial endocarditis were recorded in the 3 months after the procedure. A mean decrease in INR by approximately 1.0 U (from 2.95 +/- 0.59 to 1.87 +/- 0.46) occurred after 2 days' warfarin suspension. Seven days after rein itiation of warfarin, INR values returned to the therapeutic range in 90% o f cases. The calculated average time spent at INR less than 2.0 (critical v alue) was 28 hours. Two days' warfarin suspension is a simple and safe poli cy for patients with prosthetic heart values undergoing dental surgery.