By Renee Prajer RDH, MS, and Gwen Grosso RDH, MS
Patients with a history of vascular events such as transient ischemic attacks or cerebral vascular accidents are often placed on anticoagulation/antiplatelet therapy to prevent an embolism or thrombosis. The dental hygienist's role in treating patients on anticoagulation/antiplatelet therapy is to recognize that abnormal bleeding may occur during comprehensive care. Warfarin (Coumadin) is the most typically prescribed medication for patients on anticoagulation therapy. Patients on Coumadin therapy require laboratory testing to determine current clotting time prior to dental treatment. The laboratory tests commonly used are the Prothrombin Time (PT) and the International Normalized Ratio (INR). The INR is a comparative rating that allows for the interpretation of PT with respect to other laboratory analysis. The target INR is between 2.5 and 3.5 when providing comprehensive dental care.
Platelet aggregation inhibitors are also being prescribed including Dipyridamole (Persantine), Clopidogrel (Plavix), and Ticlopidine (Ticlid) that do not alter PT or INR. These medications do not affect bleeding related to dental treatment. Patients on platelet aggregation inhibitors do not require laboratory testing but should be carefully monitored during the dental appointment. The dental hygienist should be aware that consultation with the patient's physician is prudent to determine the patient's medical status and the need for possible alteration of prescribed medication.
• Little J et al: Dental Management of the Medically Compromised Patient, 2002, Mosby
• Requa-Clark, Barbara: Applied Pharmacology for the Dental Hygienist, ed 4 Missouri, 2000, Mosby
Renee G. Prajer, RDH, MS, is assistant professor and junior clinic coordinator at the University of New Haven, West Haven, Conn. Gwen Grosso, RDH, MS, is assistant professor and the community-based coordinator at the University of New Haven, West Haven, Conn.