pharmacology question: warfarin

[firefly101]

I am studying for my pharmacology final and going over practice problems. I am stuck between choice a and choice b for this next question. could i have some help? thank you :)

26. What should the nurse teach a patient about precautions before dental surgery when the patient is prescribed long-term warfarin therapy?

a. No action is needed ??

b. Inform the dentist of the most recent international normalized ratio (INR) results. ???

c. Stop warfarin 3 days before dental surgery.

d. Take half of the normal dose of warfarin for 3 days before dental surgery.

My book states: "Does warfarin increase bleeding during dental surgery? Yes, but not that much. Accordingly, most patients needn't interrupt warfarin for dental procedures, including dental surgery. However, it is important that the INR be in the target range"

would a dentist need to know if the INR is in range or just the health care provider?

[Shorty11, BSN, RN]

I am a nursing student, not a nurse. I recently passed Pharmacology with an A though. If this was on a Pharm test, I would choose B as the most correct choice. Patients who are on anticoagulation therapy are educated to inform their health care professionals that they are on anticoagulation drugs. Other posters are right, in this case the dentist is the health care professional. I think C & D are beyond the scope of nursing. Nurses should not tell patients to stop or lower their dose of medication without a doctor's order. I think A is wrong because I believe the dentist should be informed of the fact that the patient is on warfarin. This way the dentist can be prepared for the patient to (possibly) have a longer bleeding time than someone who is not on an anticoagulant. I believe choice B is correct because the latest INR results will give the dentist an idea of how much longer the bleeding time may be. The dentist will be able to interpret the INR results. If the patient is outside of the therapeutic range (on the higher end), the dentist can then anticipate that the patient will have an extended bleeding time. The dentist can determine if the INR is too far out of the therapeutic range to proceed with the surgery safely. The dentist can then collaborate with the doctor who prescribed the medication on what the next step should be.

Our Pharm teacher also said she would hunt us down if we called heparin, warfarin, etc. a "blood thinner". LOL. Calling anticoagulation drugs "blood thinners" is a misnomer. They do not change the thickness of blood. Instead, they inhibit the aggregation of platelets by inhibiting certain clotting factors. By doing so, they lengthen clotting (bleeding) time and prevent thrombi from forming or growing larger. Careful monitoring of coagulation lab values is needed for patients on anticoagulants. I think what GrnTea said was excellent. I also agree with CT Pixie.