dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs (warfarin) 2 to 3 days before the procedure instead of alternative strategies (Grade 2C). Warfarin should not be initiated alone, and the parenteral anticoagulant should not be discontinued until the INR is in the therapeutic range for two consecutive days.Depending on the patient's risk of thromboembolism and bleeding, bridging should occur when a patient's oral anticoagulation therapy needs to be interrupted Aortic valve prosthesis (caged-ball ortilting-disk)Patients with a history of stroke or TIAmore than 3 months before surgeryand a CHADS2 score < 5Patients undergoing surgeries with highrisk of thromboembolismPatients with a history of stroke orTIA more than 3 months beforesurgery and a CHADSPatients undergoing surgeries withhigh risk of thromboembolismPrevious thromboembolism during temporaryvitamin K antagonist interruptionPatients undergoing surgeries with high riskof thromboembolismDental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginningapproximately 24 hours after the procedureStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginning 48 to72 hours after the procedureAortic valve prosthesis (bileaflet) and atleast 1 of the following: age older than75 years; atrial fibrillation; congestiveheart failure; diabetes mellitus;hypertension; prior stroke or TIADental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisLow (base bridging onpatient- and surgeryrelatedfactors‡)Stop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginningapproximately 24 hours after the procedureHigh (base bridging onpatient- and surgeryrelatedfactors‡)Stop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginning 48 to72 hours after the procedureAortic valve prosthesis (bileaflet) withoutatrial fibrillation and no other stroke riskfactorsSingle VTE occurred > 12 months ago andno other risk factorsDental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyAortic valve prosthesis (caged-ball ortilting-disk)Patients with a history of stroke or TIAmore than 3 months before surgeryand a CHADS2 score < 5Patients undergoing surgeries with highrisk of thromboembolismPatients with a history of stroke orTIA more than 3 months beforesurgery and a CHADSPatients undergoing surgeries withhigh risk of thromboembolismPrevious thromboembolism during temporaryvitamin K antagonist interruptionPatients undergoing surgeries with high riskof thromboembolismDental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginningapproximately 24 hours after the procedureStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginning 48 to72 hours after the procedureAortic valve prosthesis (bileaflet) and atleast 1 of the following: age older than75 years; atrial fibrillation; congestiveheart failure; diabetes mellitus;hypertension; prior stroke or TIADental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisLow (base bridging onpatient- and surgeryrelatedfactors‡)Stop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginningapproximately 24 hours after the procedureHigh (base bridging onpatient- and surgeryrelatedfactors‡)Stop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyTherapeutic dose of LMWH before the procedure† and beginning 48 to72 hours after the procedureAortic valve prosthesis (bileaflet) withoutatrial fibrillation and no other stroke riskfactorsSingle VTE occurred > 12 months ago andno other risk factorsDental: continue warfarin with an oral prohemostatic agent or stop warfarin2 to 3 days before procedureDermatologic: continue warfarin and optimize local hemostasisStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyStop warfarin 5 days before surgery and restart 12 to 24 hours postoperativelyFor all warfarin indications, perioperative bridging is not indicated in patients at low risk of thromboembolism.The effectiveness of warfarin is well-established; however, it is a suboptimal anticoagulant because it requires frequent monitoring and dosage adjustments, and because of its potential for multiple drug-drug, drug-food, and drug–disease state interactions.
Evidence-based adjustment of warfarin (Coumadin) doses. (ii) not publish any content or item submitted for posting on CDA Oasis; (iii) remove any content or item that had been posted to CDA Oasis.Publications of an advertisement does not necessarily imply that the Canadian Dental Association agrees with or supports the claims.Avis de non-responsabilité: CDA Oasis ne fournit pas de conseils médicaux, de diagnostics ou de traitements.
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