As a dentist, spotting a blood thinner on a patient’s medication list is practically second nature—and when you see Warfarin, it’s like a red flag waving in front of you. But beyond recognizing it as a potential concern, do you truly know what steps to take for a patient on Warfarin? Do you stop treatment, adjust their meds, or consult their physician? Understanding how to navigate the complexities of anticoagulation therapy is crucial—not just for patient safety, but for your own peace of mind in providing top-notch care without unnecessary complications. Below, our expert pharmacist Dr. Teresa Mendoza explores what you really need to know about Warfarin:
Generic Name: Warfarin
Brand Name(s): Coumadin, Jantoven
Pronunciation: WAR far in
About this drug:
Warfarin is used to reduce the development of blood clots and to prevent heart attacks and strokes.
Dentistry-related tidbits:
Warfarin may cause gingival bleeding and a change in taste.
Patients 60 years or older may have a longer bleeding time.
Never stop a patient's blood thinner medication. Consult the patient's physician at least a week in advance if you are going to perform a dental procedure that may cause bleeding. The physician may change the blood thinner prescription.
The physician may want to take the patient off of Warfarin and bridge with the blood thinner Lovenox. Generally, patients don’t like using Lovenox because it is only given as an injection. Schedule the treatment plan accordingly to minimize the number of times a patient may need to go on Lovenox.
Many medications commonly prescribed in the dental setting may increase the risk of bleeding (including serious bleeding) when combined with Warfarin. These include:
Antivirals (e.g. Valacyclovir)
Antifungals (e.g. Ketoconazole)
Alprazolam (benzodiazepine)
Tramadol (narcotic)
Penicillin antibiotics (e.g. Amoxicillin)
NSAIDs (e.g. Meloxicam)
Macrolide antibiotics (e.g. Azithromycin)
Cephalosporin antibiotics (e.g. Cephalexin)
Quinolone antibiotics (e.g. Levofloxacin)
Clindamycin (lincosamide antibiotic)
Tetracycline antibiotics (e.g. Doxycycline)
Combining steroids or the antifungal Terbinafine with Warfarin may alter the INR (the measure of the tendency to bleed or bruise).
Combining the anticonvulsant Carbamazepine with Warfarin may decrease the levels and efficacy of Warfarin.
Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Warfarin works by inhibiting the synthesis of Vitamin K-dependent clotting factors and anticoagulant proteins.
Patients should maintain a regular Vitamin K intake (e.g. spinach, broccoli, kale) to keep a stable INR.
The FDA issued an FDA Black Box Warning regarding the importance of regular lab blood work since Warfarin can cause major or fatal bleeding. Some risk factors include: INR > 4.0, patients 65 years and older, history of GI bleeding, hypertension, anemia, malignancy, renal impairment, genetic factors, drug interactions, and long Warfarin exposure.
According to the ADA, the risks of stopping or reducing blood thinner regimens (i.e., taken to prevent thromboembolism, stroke, or MI) far outweigh the consequences of prolonged bleeding, which can be controlled with local measures.
Advise patients to avoid consuming alcohol to decrease the risk of bleeding and liver problems.
Warfarin was first discovered in 1948 as rat poison and later became a popular blood thinner, which is listed on the WHO Essential Medicines list.
Join us in ending smile denial™️ by signing up for the Digital Drug Handbook™️ today!
Comments