Management of a maxillofacial trauma patient on warfarin

ABSTRACT

Maxillofacial trauma patients with prosthetic heart valves are a challenge to treat due to the risk of bacterial endocarditis. These patients are on anticoagulant therapy therefore, they are at a risk of bleeding and thrombosis. A case of 55 year old known epileptic male patient, with mitral valve replacement surgery performed in 1988, who presented to oral and maxillofacial surgery department, Khyber College of Dentistry, with fracture mandible due to fall is reported. The patient was on warfarin with an INR raised to 9.5 and a prothrombin time of 100 seconds. Routine investigations for general anaesthesia were performed and were in the normal range. Open reduction of the fractured mandible was planned under general anaesthesia, and the patient was switched from warfarin to low molecular weight heparin and INR and PT were lowered to 1.9 and 23 seconds respectively a day before surgery. Uneventful surgery was performed and complete recovery was achieved within 3 days