***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: This prospect i ve r and omized study analyses the use of a prescribed 4.8 % tranexamic acid post-operative mouthwash over 2 days vs 5 days to prevent bleeding in patients taking warfarin who require dental extraction s. Eighty-five patients therapeutically anticoagulated with warfarin for various conditions , ranging in age from 21 to 86 years and requiring dental extraction s , were r and omly divided into two groups . Group A postoperatively received a 4.8 % tranexamic acid mouthwash to be used over a 2-day period . Group B received the same mouthwash and instructions postoperatively , to be taken over 5 days . All procedures were performed on an ambulatory basis under local anaesthetic by the same surgeon . Patients were review ed 1 , 3 , and 7 days postoperatively to assess bleeding . Eighty-two of the 85 patients encountered no postoperative problems . Two patients in group A and one in group B had minor postoperative bleeds that required minor ambulatory intervention to control . This study shows that a 2-day postoperative course of a 4.8 % tranexamic acid mouthwash is as equally effective as a 5-day course in controlling haemostasis post-dental extraction s in patient 's anticoagulated with warfarin This study evaluated the early hemostatic effects of a novel hemostatic agent ( Ankaferd blood stopper [ ABS ] ) during dental extraction s in patients on antithrombotic therapy  , without interruption or diminution of the medication . In total , 25 patients , who are on antithrombotic therapy and in need of simple dental extraction s , were r and omized into 2 groups . In group I ( control group ) , which consisted of 10 patients , local hemostasis was achieved with direct packing with gauze . In group II , which consisted of 15 patients , local hemostasis was achieved by the local application of ABS on the extraction sockets . The bleeding time was compared between 2 groups following the tooth extraction . The bleeding time in the dental sockets treated with ABS was statistically lower compared to the sockets of the control group ( p = 0.0001 ) . It is concluded that the dental extraction s could be performed without interruption of the medication in patients on antithrombotic therapy . The ABS appears to be sufficient as an alternative hemostatic agent This article concerning the pharmacokinetics and pharmacodynamics of vitamin K antagonists ( VKAs ) is part of the American College of Chest Physicians Evidence -Based Clinical Practice Guidelines ( 8th Edition ) . It describes the antithrombotic effect of the VKAs , the monitoring of anticoagulation intensity , and the clinical applications of VKA therapy and provides specific management recommendations . Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh the risks , burdens , and costs . Grade 2 recommendations suggest that the individual patient 's values may lead to different choices . ( For a full underst and ing of the grading , see the " Grade s of Recommendation " chapter by Guyatt et al , CHEST 2008 ; 133:123S-131S . ) Among the key recommendations in this article are the following : for dosing of VKAs , we recommend the initiation of oral anticoagulation therapy , with doses between 5 mg and 10 mg for the first 1 or 2 days for most individuals , with subsequent dosing based on the international normalized ratio ( INR ) response ( Grade 1B ) ; we suggest against pharmacogenetic-based dosing until r and omized data indicate that it is beneficial ( Grade 2C ) ; and in elderly and other patient subgroups who are debilitated or malnourished , we recommend a starting dose of < or = 5 mg ( Grade 1C ) . The article also includes several specific recommendations for the management of patients with nontherapeutic INRs , with INRs above the therapeutic range , and with bleeding whether the INR is therapeutic or elevated . For the use of vitamin K to reverse a mildly elevated INR , we recommend oral rather than subcutaneous administration ( Grade 1A ) . For patients with life-threatening bleeding or intracranial hemorrhage , we recommend the use of prothrombin complex concentrates or recombinant factor VIIa to immediately reverse the INR ( Grade 1C ) . For most patients who have a lupus inhibitor , we recommend a therapeutic target INR of 2.5 ( range , 2.0 to 3.0 ) [ Grade 1A ] . We recommend that physicians who manage oral anticoagulation therapy do so in a systematic and coordinated fashion , incorporating patient education , systematic INR testing , tracking , follow-up , and good patient communication of results and dose adjustments [ Grade 1B ] . In patients who are suitably selected and trained , patient self-testing or patient self-management of dosing are effective alternative treatment models that result in improved quality of anticoagulation management , with greater time in the therapeutic range and fewer adverse events . Patient self-monitoring or self-management , however , is a choice made by patients and physicians that depends on many factors . We suggest that such therapeutic management be implemented where suitable ( Grade 2B ) OBJECTIVE The objective of this study was to compare the use of a resorbable oxycellulose dressing with a fibrin adhesive for the prevention of post extraction hemorrhage in patients taking anticoagulants . STUDY DESIGN A control group of 26 patients with a preoperative international normalized ratio ( INR ) in the range of 2.0 to 4.2 had extraction s performed with the use of local anesthesia  and the socket(s ) dressed with a resorbable oxycellulose dressing and sutured with a resorbable suture . The study group with a comparable INR range of 2.1 to 4.1 was treated in a similar manner , except the sockets were dressed with a fibrin adhesive . RESULTS No discernible difference in the postoperative outcome with regard to hemorrhage was noted . Postoperative pain was reported more frequently in the group that used a resorbable oxycellulose dressing . Only 1 patient had significant postoperative bleeding . CONCLUSIONS This study shows that in patients receiving warfarin whose INR is within the therapeutic range , the fibrin adhesive is as effective as the resorbable oxycellulose dressing in preventing post extraction hemorrhage BACKGROUND Significant uncertainty surrounds the treatment of patients who must discontinue warfarin sodium therapy before an invasive procedure . In part , the uncertainty results from the lack of published information about the risk of thromboembolism associated with short-term warfarin therapy interruption . We aim ed to assess the frequency of thromboembolism and bleeding within a large cohort of patients whose warfarin therapy was temporarily withheld for an outpatient invasive procedure . METHODS This prospect i ve , observational cohort study was performed at 101 sites ( primarily community-based physician office practice s ) in the United States . Enrollment was conducted from April 4 , 2000 , to March 6 , 2002 . The main outcome measures were thromboembolism or clinical ly significant hemorrhage within 30 days of  warfarin therapy  interruption . RESULTS A total of 1293 episodes of warfarin therapy interruption in 1024 individuals were included . The mean ( SD ) patient age was 71.9 ( 10.6 ) years ; 438 ( 42.8 % ) were female . The most common indications for anticoagulant therapy were atrial fibrillation ( n=550 ) , venous thromboembolism ( n=144 ) , and mechanical heart valve ( n=132 ) . The most common procedures were colonoscopy and oral and ophthalmic surgery . Perioperative heparin or low-molecular-weight heparin was used in only 8.3 % of cases overall . Seven patients ( 0.7 % ; 95 % confidence interval [ CI ] , 0.3%-1.4 % ) experienced postprocedure thromboembolism within 30 days . None of the 7 patients who experienced thromboembolism received periprocedural bridging therapy . Six patients ( 0.6 % ; 95 % CI , 0.2%-1.3 % ) experienced major bleeding , whereas an additional 17 patients ( 1.7 % ; 95 % CI , 1.0%-2.6 % ) experienced a clinical ly significant , nonmajor bleeding episode . Of these 23 patients who had bleeding episodes , 14 received periprocedural heparin or low-molecular-weight heparin . The duration of warfarin therapy interruption was variable ; however , more than 80 % of patients had warfarin therapy withheld for 5 days or fewer . CONCLUSIONS For many patients receiving long-term anticoagulation who need to undergo a minor outpatient intervention , a brief ( < or = 5 days ) periprocedural interruption of warfarin therapy is associated with a low risk of thromboembolism . The risk of clinical ly significant bleeding , even among out patients undergoing minor procedures , should be weighed against the thromboembolic risk of an individual patient before the administration of bridging anticoagulant therapy Objectives To examine the consequences of temporary withdrawal of warfarin and /or suturing on bleeding and healing pattern following dental extraction s. Methods Two hundred and fourteen patients on long-term oral anticoagulation ( warfarin ) therapy scheduled for dental extraction were r and omly divided into four groups : no suturing and discontinued ( group 1 ) or continued warfarin ( group 2 ) , and suturing and discontinued ( group 3 ) or continued warfarin ( group 4 ) . International normalised ratio ( INR ) was determined at different time points ( baseline , days 1 , 3 and 7 ) . Results Discontinuing warfarin reduced INR level significantly at day 1 , which subsequently reached < 1.5 in 96 out of 104 patients ( group 1 and 3 ) . Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern . Interestingly , patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls . Conclusion Dental extraction s may be safely performed for patients on anticoagulation therapy provided the INR level is kept < 3.0 and effective measures of local haemostasis are administered . The decision to suture should be made on case-by-case basis , as the trauma associated with soft tissue h and ling might outweigh its advantages in certain situations like simple extraction PURPOSE Our goal was to evaluate the local hemostatic effect of n-butyl-2-cyanoacrylate ( Histoacryl ; B. Braun , Melsungen , Germany ) glue in warfarin-treated patients who undergo outpatient oral surgery without a change in their level of anticoagulation . MATERIAL S AND METHODS Thirty consecutive warfarin-treated patients r and omly assigned to study and control groups and 10 patients who had never been on anticoagulant therapy serving as the negative control group were included in this trial . Before multiple teeth extraction s , all patients had a prothrombin time and the international normalized ratio ( INR ) determined . To gain hemostasis and primary closure , gelatin sponge and multiple interrupted resorbable sutures were used in the control and negative control groups , and Histoacryl glue and the minimal number of interrupted resorbable sutures were used in the study group . Postoperatively , patients were to contact the oral surgeon if abnormal bleeding occurred . Patients who did not have postoperative bleeding  were seen on the 10th postoperative day . Data were collected , and statistical differences in age and gender distributions , number of teeth extracted , INR levels , and bleeding that required treatment were analyzed with the Mantel-Haenzel test . Statistical significance was defined as a value of P < .05 . RESULTS Local hemostasis was obtained immediately in study patients and only after 10 to 20 minutes in the control and negative control patients . In relation to bleeding complications , there were no cases of postoperative bleeding requiring treatment in both the negative control patients and study patients . In the control patients , 5 cases had postoperative spontaneous bleeding that required treatment . This difference was statistically significant . No patient had wound infection and the healing process appeared to be normal . CONCLUSION Multiple extraction s can be performed in patients taking oral anticoagulant therapy  without a change in their level of anticoagulation provided an efficient local hemostatic measure is instituted . And , in this regard , Histoacryl glue , used as a topical adhesive over approximated wound edges , is an effective and easily applicable local hemostatic for oral surgery in such patients PURPOSE The aim of this prospect i ve study was to compare the effectiveness of a 4.8 % tranexamic acid mouthwash versus an autologous fibrin glue preparation to control hemostasis in patients therapeutically anticoagulated with warfarin who required dental extraction s without interruption of their treatment . PATIENTS AND METHODS The 49 patients who underwent 152 dental extraction s were r and omly allocated to 2 groups : Group A were required to rinse with 10 mL of a 4.8 % tranexamic acid solution 4 times a day for 7 days postoperatively . Group B received autologous fibrin glue intraoperatively . The international normalized ratio was measured on the day of the procedure . All procedures were performed on an ambulatory basis by the same surgeon . RESULTS Of the 49 patients , 2 presented with postoperative bleeding ( 4 % ) . Both patients were from the autologous fibrin glue group and were found to have grossly elevated international normalized ratios on the day of the bleeding that was unaccounted for . CONCLUSIONS This study supports the consensus that dental extraction s 
    Output:
    
Patients with an INR within the therapeutic range can safely continue taking the regular dose of warfarin before dental extraction s. There is no evidence to support or reject the superiority of local hemostatic agents over warfarin discontinuation