Does prophylactic antibiotic administration for tooth extraction affect PT-INR in patients taking warfarin?
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RESEARCH ARTICLE
Open Access
Does prophylactic antibiotic administration for tooth extraction affect PT‑INR in patients taking warfarin? Eiji Iwata1,2*, Akira Tachibana1, Junya Kusumoto2, Naoki Takata1, Takumi Hasegawa2 and Masaya Akashi2
Abstract Background: Various antibiotics and analgesics have been reported to interact with warfarin. Reports that investigate the effects of medication taken for just a few days during tooth extraction on the prothrombin time-international normalized ratio are rare. Methods: A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured 1 month before the tooth extraction, the day of the extraction, and 1 week after the extraction. We investigated the changes in INR values between the day of extraction and 1 week after extraction, as well as the various risk factors for increases in INR values. Results: Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 out of 110 patients (0.9%). Conclusion: Our results suggest that prophylactic antibiotic administration has little effect on INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction. Keywords: Antibiotics, Analgesics, Warfarin, Tooth extraction, International normalized ratio Background Various antibiotics and analgesics have been reported to interact with warfarin [1–5]. When tooth extraction is performed, patients are usually prescribed antibiotics to prevent surgical site infection (SSI) or infective endocarditis (IE) and analgesics to decrease pain. These drugs may also interact with warfarin and produce a clinically significant alteration in anticoagulation status. However, most previous reports were on long-term treatment *Correspondence: [email protected]‑u.ac.jp 1 Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon‑machi, Kakogawa‑cho, Kakogawa 675‑8611, Japan Full list of author information is available at the end of the article
cases and cases where oral intake was not possible [1–5]. To our knowledge, there is only one report that investigated the effects of medication that was administered for just a few days for tooth extraction on the prothrombin time-international normalized ratio (PT-INR) [6]. This study investigated the effect of azithromycin (AZM) on INR values in patients taking warfarin [6]. In the present study, we retrospectively investigated the effects of various antibiotics ad
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