Dental Extracion in Patients on Warfarin Treatment

Objective: To assess the incidence of bleeding after dental extractions in subjects taking warfarin continuously before and after extractions whose International Normalised Ratio (INR) was below 3.5 at the time of extraction. Methods: Fifty patients taking warfarin who had been referred to the Oral and Maxillofacial Department, govt. dental college Srinagar for dental extractions were included in the study. Exclusion criteria included patients with an INR less than 3.5 or with a history of liver disease or coagulopathies. No alteration was made in warfarin dose. Bleeding from the extraction site was evaluated and recorded immediately after extraction until the second day. Results: A total of 50 patients (34 women and 16 men) aged between 42 and 60 years (mean =51) were included in the present study. All patients underwent simple one-tooth extraction while undergoing warfarin treatment. Oozing, considered mild bleeding and which did not need intervention was seen in 88 % of patients. Moderate bleeding occurred in 12 % of all cases. The INR of the patients ranged from 1.5 to 3.5 with 68 % of patients having INR between 1.6 and 2.0 on the day of extraction. No severe bleeding which needed hospital management was encountered after any of the extractions. The patients who suffered moderate bleeding were returned to the clinic where they received local treatment measures to control bleeding. Moderate bleeding occurred only in six patients, where four had INR between 2.6 and 3.0, and two with INR less than 3. Conclusion: Patients taking warfarin whose INR is up to 3.5 and who have dental extractions in hospital do not have clinically significant bleeds post-operatively.