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| Title |
Preoperative Discontinuation of Warfarin for Dental Surgery Not Indicated for Most Patients |
| Clinical Question |
In patients being treated with warfarin, should anticoagulant treatment routinely be interrupted before undergoing dental extractions or is local hemostasis an adequate method to reduce risk of excessive bleeding? |
| Clinical Bottom Line |
Patients being therapeutically anti-coagulated with warfarin (at an International Normalized Ratio (INR) of less than 4), can undergo dental extractions without discontinuation of anticoagulant therapy considering proper local hemostatic measures are used. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 21196857 | Rodriguez-Cabrera/2011 | Anticoagulated Patients | Systematic review of randomized trials | | Key results | Compilation of a sample of 1194 patients from the articles selected. All of the patients were prescribed on long-term anticoagulant treatment. The anticoagulant treatment was not suspended in any of the cases and the INR value was maintained within therapeutic ranges. Of the sample, 83 patients presented a certain degree of bleeding; in 77 of such cases, the bleeding was controlled with local hemostasis, whereas 6 patients required their dose of oral anticoagulants to be adjusted. | | #2) 19239742 | Nematullah/2009 | Patients on Warfarin Therapy | Meta-Analysis | | Key results | Continuing the regular dose of warfarin therapy does not confer an increased risk of bleeding compared with discontinuing or modifying the warfarin dose for patients undergoing minor dental procedures. | | #3) 14649397 | Carter/2003 | Patients taking Warfarin requiring Extractions | Systematic review of randomized trials | | Key results | Patients therapeutically anti-coagulated with warfarin can be treated without interruption of their warfarin regimen provided appropriate local measures are used. | | #4) 21196857 | Wahl/1998 | Patients on Oral Anticoagulant therapy requiring oral surgery | Systematic review of randomized trials | | Key results | Although there is a theoretical risk of hemorrhage after dental surgery in patients who are at therapeutic levels of anti-coagulation, the risk appears to be minimal, the bleeding usually can be easily treated with local measures, and this risk may be greatly outweighed by the risk of thromboembolism after withdrawal of anticoagulant therapy. | |
| Evidence Search |
PubMed Search; “Warfarin/therapeutic use” MeSH, “Tooth extraction” MeSH, “Postoperative Hemorrhage” MeSH |
Comments on
The Evidence |
Numerous research articles detail clinical trials for the management of anti-coagulated patients needing dental extractions. The articles selected represent a review of multiple clinical trails and research available reach a literature-supported conclusion. |
| Applicability |
Applicable to providers managing patients on warfarin needing dental extractions. |
| Specialty/Discipline |
(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene) |
| Keywords |
Anticoagulation, Warfarin, Dental extractions, Local hemostasis
|
| ID# |
2600 |
| Date of submission: |
11/06/2013 |
| E-mail |
amana.farrkh@ucdenver.edu |
| Author |
Amana Farrkh |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Thomas Borris, DDS |
| Faculty mentor/Co-author e-mail |
thomas.borris@ucdenver.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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