Table 3.67.
Key considerations for dental management in heparinisation (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Excessive bleeding |
| Appropriate dental care | 2/3 | Consider alternatives to surgery; in case of emergency use protamine |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Avoid regional block |
| – Conscious sedation | 1 | |
| – General anaesthesia | 1 | Avoid nasal intubation |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1/2 | Dental treatment should be performed at least 6 hours after injection; or the day after dialysis; or prior to the daily dose of a LMW heparin |
| – Patient positioning | 0 | |
| Treatment modification | ||
| – Oral surgery | 3 | Local haemostatic measures |
| – Implantology | 3/5 | |
| – Conservative/Endodontics | 1 | |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 1 | |
| – Non-surgical periodontology | 3 | |
| – Surgical periodontology | 3 | |
| Hazardous and contraindicated drugs | 2 | Avoid aspirin and other NSAIDs; avoid intramuscular injections |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.