Current concepts of the management of dental extractions for patients taking warfarin

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Background: Controversy has surrounded the correct management of patients therapeutically anticoagulated with warfarin who require dental extractions. The risk of bleeding must be weighed up against the risk of thromboembolism when deciding whether to interfere with a patient's warfarin regimen. An improved understanding of the importance of fibrinolytic mechanisms in the oral cavity has resulted in the development of various local measures to enable these patients to be treated on an outpatient basis. Methods: A review of the literature was undertaken. This was supplemented by the authors' clinical trials and extensive clinical experience with anticoagulated patients. Results: Various protocols for treating patients taking warfarin have been reviewed and summarized and an overview of the haemostatic and fibrinolytic systems is presented. A protocol for management of warfarinized patients requiring dental extractions in the outpatient setting is proposed. Conclusions: Patients therapeutically anticoagulated with warfarin can be treated on an ambulatory basis, without interruption of their warfarin regimen provided appropriate local measures are used.G Carter, AN Goss, JV Lloyd, R Tocchett

Not saying, not doing: Convergences, contingencies and causal mechanisms of state reform and decentralisation in Hollande’s France

Are States in contemporary Europe subject to new forms of convergence under the impact of economic crisis, enhanced European steering and international monitoring? Or is the evolution of governance (national and sub-national) driven fundamentally by diverging, mainly domestic pressures? Drawing on extensive new data, the article combines analysis of the State Modernisation and Decentralisation reform programmes of the Hollande–Ayrault administration, drawing comparisons where appropriate with the previous Sarkozy regime. The limits of President Hollande’s anti-Sarkozy method were demonstrated in the first 2 years; framing state reform and decentralisation in negative terms prevented the emergence of a coherent legitimising discourse. The empirical data is interpreted with reference to a comparative ‘States of Convergence’ framework, which is conceptualised as a heuristic device for analysing variation between places, countries and policy fields. The article concludes that the forces of hard convergence are gaining ground, as economic, epistemic and European pressures continually challenge the forces of institutional inertia