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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Richard E. Fredekind, Alex McDonald, and Bruce Peltier. School of Dentistry, University of the Pacific, 2155 Webster Street, San Francisco, CA 94115, 415-929-6604, rfredeki@sf.uop.edu
Warfarin is an anticoagulation agent prescribed for the treatment of venous thrombosis, pulmonary embolus, and atrial fibrillation, and following a heart attack, stroke, or cardiac valve replacement. Strict adherence to a precise dosing regimen is vital to maintaining correct therapeutic values and is based on the International Normalized Ratio (INR). Historically, dentists have been instructed to interrupt warfarin therapy when doing invasive procedures using written consultations sent to treating physicians. More recent approaches, however, do not always support the discontinuance of warfarin therapy. The intent of this study was to examine the current nature of communication between dentists and physicians who are responsible for the anticoagulation therapy of shared patients. Active and inactive charts (n=10,539) in a private dental school were screened. Ninety-two patients (0.87%) were found to have taken warfarin during dental treatment. From this group, 76 patient charts with 137 written consultations conformed to the protocol for acceptance and were carefully reviewed. Sixty-six percent of the patients were taking warfarin for treatment of atrial fibrillation or aftercare following a stroke. The most common dental procedures to be completed on these patients were simple periodontics (54.7%), oral surgery (48.1%), and restorative dentistry (36.5%). Regarding the advice received from physicians, 51.8% preferred that their patient discontinue taking warfarin for a specified number of days prior to and after treatment. The average number of days patients were to discontinue warfarin was 3.83, with a range of 1 to 12 days (compared to the suggested standard of just over two days). Only 28.5% of patients had an INR provided on the returned consult while 15.3% of patients had their INR checked before the dental procedure. Just over half (51.8%) of the patients had dental surgical procedures planned that met suggested standards for interruption of warfarin therapy. Recommendations include eliminating unnecessary consultations, communicating more precisely in consultations, having the dentist order the INR within 24 hours of surgery, involving physicians only when the INR is above therapeutic range (>3.0), and providing good surgical technique and aftercare.
Learning Objectives:
Keywords: Health Care Quality, Decision-Making
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.