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Following a conversation earlier myself and a collegue were discussing INR levels needed to undertake nail surgery and I wondered what level other people used. I was always taught the level needed to be around 2 where as my collegue says 2.2, does 0.2 make a great difference? What do others use?

 

What proposed nail surgery? What signs and symptoms? What age, physical condition, co-morbidities, sex, PMHx, family Hx, social Hx, other tests etc?

I don't think it advisable to rely too much on numbers from a single test; this can be:

i) misleading
ii) inaccurate
ii) inappropriate

All the best

Bill Liggins

 

I have had a coupe of patients who are on antiecoagulants awating nail surgery and as the INR lvls differ for each individual I allways ring the there antiecoagulant clinic and ask them what would they like them to be at! I have allways found it to be at about 1.5!
Hope this helps

 

Hi Paul
you might find these guidelines produced by our department useful.
Michael

 

Bill - Thank you, I appreciate that every patient is different so each one needs to be treated as an individual, but wondered if there was a level people based their guidelines on.

Michael - thats great, thank you!

 

The NHS Guidelines posted by Michael are excellent. They reflect the evidence very well, particularly in dentistry, dermatology and elsewhere in medicine. There is really no need to ever reduce or stop warfarin for minor cutaneous surgery. However, the guidelines should be more explicit about the number of cups of tea required whilst waiting for bleeding to stop. ;)

LL

 

There is a product sold to dentists that is very efficiently haemostatic. I can't recall the name sorry... can look on Monday if anyone so desires. I keep it in my clinic and I don't worry about the INR. If things get bloody after I use a square of that and some digital pressure and all is sweet in 5 minutes. Having said that, I use trichlor as my cautery agent and it will virtually never result in bleeding as it causterises the vessels well too. The dental stuff is pretty expensive but then again, I'm not thru the packet I bought in 1992 yet !