Can warfarin be continued during dental extraction? Results of a randomized controlled trial

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

“…Nine patients who had delayed bleeds were treated at home following the provision of simple advice over the telephone. 32 Conclusions from a recently published case series study 33 of 150 patients on warfarin also support the view that provided the INR is between 2-4, extractions can be carried out in primary care without the risk of a signifi cant bleed.…”

“…1,2,22,32,33 For example a randomised controlled trial of 57 anticoagulated patients found no increase in clinically important bleeding, with only one patient requiring admission to hospital for observation after closure of an oral-antral communication. Nine patients who had delayed bleeds were treated at home following the provision of simple advice over the telephone.…”

“…The majority of guidelines and recommendations 4,20,27,32,33 have focused on surgical aspects of dentistry. There has only been limited information available on the management of patients requiring restorative treatment.…”

Dental management of patients receiving anticoagulation or antiplatelet treatment

“…Although the risk is low, the outcome is serious. This must be balanced against the fact that there is no single report of uncontrollable bleeding when dental procedures have been carried out without stopping antiplatelet or anticoagulation medications (21).…”

“…The majority of publications that have considered the risks of stopping versus continuing anticoagulation or antiplatelet therapy for dental procedures have concluded that most dental patients can undergo procedures without stopping their therapies provided that local haemostatic measures are used to control bleeding (11,17,21,24,25).…”