Key Points
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Dental extractions can be safely performed on patients receiving warfarin therapy without stopping or altering the dose of anticoagulant.
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The chances of a thromboembolic attack may be significantly higher than the chance of postoperative bleeding when anticoagulant medication is temporarily stopped.
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Mechanical pressure may be very important and beneficial in stopping postoperative bleeding compared with other alternatives.
Abstract
Objective
To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions.
Methods
Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly 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 extractions 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 handling might outweigh its advantages in certain situations like simple extractions.
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References
Evans I L, Sayers M S, Gibbons A J et al. Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg 2002; 40: 248–252.
Wahl M J. Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc 2000; 131: 77–81.
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Becker, W. Postoperative bleeding and oral anticoagulants. Br Dent J 203, 410–411 (2007). https://doi.org/10.1038/bdj.2007.914
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DOI: https://doi.org/10.1038/bdj.2007.914
