Patients with dental hemorrhagic complicationsundergoing warfarin therapy exhibit excessiveinternational normalized ratio prolongation: A report of 2 cases

Dental?hemorrhagic?complications,?including?postoperative?bleeding?and?traumatic?hemorrhage?as?emergency?cases,?often?occur?in?patients?undergoing?oral?anticoagulant?therapy?such?as?warfarin?therapy.?Recent?research?recommends?that?warfarin?dosage?should?be?assessed?every?12?weeks.?Therefore,?most?physicians?generally?accept?international?normalized?ratio?(INR)?monitoring?at?longer?intervals.?However,?cases?are?encountered?in?which?the?INR?prolongation?is?observed?despite?of?invariable?dosage?of?warfarin.?In?this?report,?we?present?2?cases?of?patients?with?dental?hemorrhagic?complications?undergoing?oral?anticoagulant?therapy?who?exhibited?excessive?INR?prolongation.?These?patients?exhibited?decreased?appetite?and?hypoalbuminemia. We?speculate?that?long-term?appetite?loss?resulted?in?the?increase?in?the?serum?concentration?of?free?warfarin and?vitamin?K deficiency. Our?study?indicates that we?should?notice malnourishment?when?we?treat patients?who?have?undergone?warfarin?therapy with dental?surgical procedures.?It?is?recommended?that measurement?of?INR just before?a?dental?surgical?treatment.