The Value of Using Bedside Point of Care Testing for International Normalized Ratio in Patients on Warfarin Undergoing Dental Procedures and Bleeding Assessment; A Single Center Prospective Study.

Abstract

Introduction: Postoperative bleeding is a significant complication in dental surgeries, especially for patients on anticoagulants. Risk stratification based on patient factors can help reduce these complications, but current tools lack accurate risk prediction.

Aim: To examine point-of-care device accuracy for measuring International Normalized Ratio (INR) compared to laboratory INR and evaluate risk factors for post-dental surgical bleeding in warfarin patients.

Methods: The primary outcome was post-operative bleeding following invasive dental procedures. INR measurements were performed using both point-of-care devices and laboratory methods. One-way ANOVA compared INR values across bleeding severity groups and procedure types. Independent samples t-test compared INR values between low (<5 mg) versus high (≥5 mg) warfarin doses. Levene's test assessed variance equality.

Results: The study included 88 patients (61.4% female, mean age 49.7 ± 14.1 years). Bleeding outcomes were: no bleeding (33.0%, n = 29), minimal bleeding (34.1%, n = 30), moderate bleeding (20.5%, n = 18), and severe bleeding (11.4%, n = 10). No significant differences existed between <5 mg versus ≥5 mg warfarin groups in point-of-care INR (2.51 vs 2.70, p = 0.235) or laboratory INR (2.54 vs 2.63, p = 0.572). Significant associations were found between physician and procedure type (p < 0.001) and between point-of-care and laboratory INR measurements (r = 0.717, p < 0.001). No correlation existed between INR level and bleeding.

Conclusion: Bleeding risk in warfarin patients undergoing dental procedures depends on procedure complexity and duration rather than INR level alone. Point-of-care INR devices demonstrated accuracy comparable to laboratory measurements, offering valuable risk assessment that may help predict bleeding risk and provide reassurance for low-risk cases.