Dental Work on Warfarin

A number of dental procedures can be done safely withouthaving to discontinue warfarin. A clinically helpful table is can be found here: Dental procedures and Warfarin (from ref 1).

Background

A common question from dentists and patients is whether warfarin needs to be interrupted for dental procedures, such as cleaning,  or root canals, or dental extractions.  Medical publications and recommendations from the dental community outlining best management of patients on warfarin exist (ref 1-6).   However, even though evidence suggests that stopping warfarin for low-risk dental procedures is not necessary, many dentists are hesitant to perform dental procedures if the patient is on warfarin.  Communication between the health care provider dealing with the patient’s warfarin management and the dentist is important to make a solid decision whether warfarin needs to be discontinued or not.

 

Existing Guidelines

Several medical guidelines from respected medical bodies exist:

• American College of Chest Physician (ACCP) guidelines (ref 2):  “In the patient undergoing minor dental procedures (single and multiple tooth extractions and root canal procedures) we recommend continuing warfarin therapy around the time of the procedure. It is reasonable to give oral (local) prohemostatic agents”.
• British Committee for Standards in Haematology (BCSH) guideline (ref 3):  “The risk of significant bleeding in patients on oral anticoagulants and with a stable international normalized ratio (INR) in the therapeutic range 2-4 (i.e., <4) is very small and the risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued.  Oral anticoagulants should not be discontinued in the majority of patients requiring out-patient dental surgery including dental extraction”.
  

References

1. Herman WW et al. Current perspectives on dental patients receiving coumarin anticoagulant therapy. Journal of the American Dental Association. 1997;128:327-335.
2. Bacci C et al. Management of dental extraction in patients undergoing anticoagulant therapy. Thrombosis and Haemostasis 2010;104:972-975.
3. Douketis J et al. Ther perioperative management of antithrombotic therapy. Chest 2008;133:299-399S.
4. www.guidelines.gov/content.aspx?id=11998 –  Perry DJ et al. Guidelines for the management of patients on oral anticoagulants requiring dental surgery. British Committee for Standards in Haematology; 2007.
5. Aframian DJ et al. Management of dental patients taking conmon hemostasis-altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(suppl 1):S45.e1-S34.e11).
6. Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. Journal of the American Dental Association. 2000;131:77-81.

 For Patients

This same information, written for patients, can be found at: https://clotconnect.wordpress.com/2010/11/12/dental-work-on-warfarin/

 

Disclosure:  I have no financial conflict of interest relevant to this blog entry.

Last updated: Jan 31st, 2011