Update on coagulopathies.

Abstract

Whether one considers endogenous or drug-induced etiologic factors, numerous patients with coagulopathies will seek dental treatment. Obviously, surgeons and dentists treating these patients must have current knowledge regarding the treatment and management of these disorders. The topic of coagulopathies is so broad that textbooks are filled with information dealing with only small areas of focus. This article reviews some of the newer developments in the area of coagulopathies. An all-inclusive review of the pathophysiology of the disease processes and their management is not possible in this limited space. Application of new drugs, changes in treatment of the common coagulopathies, changes in management of certain disease processes with anticoagulants, changes in monitoring patients who are anticoagulated, and managing the dental patient with a coagulopathy are discussed. MONITORING Two major topics warrant discussion about the monitoring of anticoagulation: international normalized ratio (INR) and patient self-management. Although the INR is not a new concept, much confusion still surrounds it. An article by Troulis et al1 surveyed oral and maxillofacial surgeons in North America and found that 73% use the INR, but only 21% rely on this method alone. INR is a value calculated from the ratio of the patient’s prothrombin time (PT) to the mean of the normal range. This value is then corrected by multiplication by the international sensitivity index (ISI). The ISI is based on a quantitative assessment of responsiveness of a thromboplastin by comparison with a reference thromboplastin. The INR system was established to standardize