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Managing patients who are taking warfarin and undergoing dental treatment
Erythromycin and other macrolide
• If patients on warfarin who require
antibiotics (for example, azithromycin)
dental surgery have an International
Macrolide antibiotics interact with warfarin
have liver impairment/high alcohol intake, renal
Normalised Ratio (INR) of below
unpredictably and only in certain individuals.
Refer to specialist services.
4.0, they can usually receive their
Patients should be advised to be vigilant
dental treatment in primary care
for any signs of increased bleeding.
without needing to stop their
warfarin or adjust their dose.
patient should be advised to contact the
• The risk of thromboembolism after
temporary withdrawal of warfarin
additional INR testing and dose review.
therapy outweighs the risk of oral
bleeding following dental surgery.
Metronidazole interacts with warfarin and
• Patients on warfarin may bleed more
should be avoided if possible. If it cannot be
than normal, but bleeding is usually
avoided, the warfarin dose may need to be
controlled with local measures.
reduced by a third to a half, and re-adjusted
Advice to be given to patients
again when the antibiotic is discontinued. Contact the GP or anticoagulant clinic to
Refer to anticoagulation service.
Reschedule the procedure when
patient leaflet, Oral Anticoagulant Therapy:
INR is less than 4.0. Refer to
Important information for dental patients.
specialist services for dental
treatment if INR remains above
4.0 or control is erratic.
that amoxicil in interacts with warfarin
causing increased prothrombin time and/or bleeding, but documented cases are
Dental surgery covered by
relatively rare. Patients requiring a course
Drug therapy: if the patient
this advice includes:
requires analgesia, use
vigilant for any signs of increased bleeding.
Treatment where the INR does not
paracetamol. Avoid non-steroidal
anti-inflammatories, for example,
ibuprofen, aspirin and diclofenac.
Clindamycin is restricted to specialist use
The use of dihydrocodeine should
and should not be used routinely for dental
only be considered for second
infections due to its serious side effects.
line pain relief when other drugs
Treatment where the INR does
There is a single case report of an interaction
are unsuitable. Codeine has
no role in dental analgesia.
There is no indication for
routine prescribing of antibiotics
for dental procedures in this
group of patients. See opposite
for further information.
All patient safety incidents should be reported to the PCT using local reporting procedures, or directly to the NPSA using the e-form on the NPSA website at www.npsa.nhs.uk. This document was produced with the support of the British Dental Association and advice from the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology (BCSH) – See www.bcshguidelines.com. The information is based on guidance from UK Medicines Information.
Surgical management of the primary care dental patient on warfarin. North West Medicines Information Centre. March 2004.
Evidence-based veterinary dermatology: a systematic review of interventions for Malassezia dermatitis in dogs Amélie Negre*, Emmanuel Bensignor† and Jacques Guillot‡ *Veterinary Clinic, 7 rue de l’Hôtel de Ville, le Châtelet-en-Brie, France†Veterinary Dermatology Referral Service, Veterinary Clinic, Paris and Cesson-Sévigné, Veterinary Hospital, Nantes, France Introduc
St. Joseph Consolidated School Emergency Medical Authorization Form 2013-2014 Purpose- To enable parents to authorize emergency treatment for children who become ill or injured while under school authority when parents cannot be reached. One form for each student must be filled out. Please complete BOTH sides Student Name: _______________________________Parent Name:__________