Warfain pts

Important to seek clearance from med

Before exo, determine INR

INR 2-2.5 : simple atraumatic exos, restorative work + local measures for bleeding control

INR 2.5-3.5 : Bleeding should not be a problem, may consult physician who may consider reduction of dose, stop warfarin or convert to heparin(stop 2 days preop, convert to heparin, postop start warfarin simultaneously with heparin, stop heparin when INR back)

Drugs to avoid:

1)potentation
Aspirin, Nsaids, paracetamol
Azoles antifungals
prolonged broad-spectrum ab (amox, ampi, tetra, cephalosporins)
metronidazole, erythromycin, sulphonamides, corticosteroids

2) inhibition
carbamazepine, azathioprine, cyclosporin, barbiturates

Local Measures - suturing, gelatine sponges, tranexamic acid(1g tds)