Dental extractions in patients on warfarin: is alteration of anticoagulant regime necessary?

An assessment of the management of patients on warfarin by general dental practitioners in South West Wales

“…Evidence related to the risk of bleeding in patients on warfarin has been mainly based on dental extractions, alveolar surgery and gingival surgery. [3][4][5][6][7] Some authors have reported that there was no increased risk of bleeding associated with routine dental procedures such as scaling and restorations. However, no treatment was carried out on these patients if their INR was above 2.5.…”

“…[3][4][5][6][7] There is no published evidence about the management of patients on warfarin undergoing dental treatment in primary care by the General Dental Services in the United Kingdom. Additional factors which may influence the management of such patients in primary care include access to hospital resources, and constraints specific to the General Dental Services in the UK that have been reported anecdotally.…”

Erratum

“…Devani et al 7 randomised 65 patients on continuous warfarin therapy and under going 133 dental extractions to either stop warfarin two to three days prior to surgery (32 patients) resulting in a reduction in mean INR from 2.6 to 1.6, or to continue anticoagulants with no dose alteration (32 patients) and a mean pre-operative INR of 2.7 (range 2.2-3.9). All patients received local measures ('Surgicel' packing and sutures) to con trol post-operative bleeding.…”

Management of patients on warfarin by general dental practitioners in South West Wales: continuing the audit cycle

“…[5][6][7][8][9] As such, a number of protocols have been advocated to reduce the risk by modifying the warfarin regime. These have included substitution, 5,6 decreasing the levels of anticoagulation, 10 or even stopping the patient's warfarin for two days pre-operatively.…”

“…9,11 Conversely, concern has been expressed about the increased risk of thromboembolic episodes in patients whose warfarin has been modifi ed to allow dental treatment to occur. 8,[12][13][14][15][16][17][18][19] The wide use of warfarin means that general dental practitioners (GDPs) are exposed to an increasing number of patients on anti-coagulant therapy. Many of these patients require procedures which could be complicated by prolonged coagulation times.…”