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 longterm 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.