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

Abdullah Albarkheel,1 Hawazen Alshareef,1 Amal Albar,1 Sohayla Youssef Altbaili,1 Mohammed Ali Alminaqash,1 Amjad Alotibie,2 Aamir Sheikh,3,4 Abdullah Alahmadi,3 Badar Alaifan,3 Hani Tamim,4 Tarek Owaidah2,4 1Dental Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 2Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 3Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4Alfaisal University, College of Medicine, Riyadh, Saudi ArabiaCorrespondence: Tarek Owaidah, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, Email [email protected]: 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.Keywords: dental surgery, bleeding, INR, warfarin

Keywords

• Dental Surgery
• Bleeding
• INR
• Warfarin