Extraction in Patients on Oral Anticoagulant Therapy With and without Stopping the Drug: A Comparative Study.

Abstract

The aim of this study was to compare postoperative hemorrhagic complications after dental extractions in two groups of patients receiving oral anticoagulants with one group receiving oral anticoagulant without interruption and another group stopping the drug 3days prior to extraction. A control group consisted of 30 patients who had stopped the oral anticoagulant 3days before undergoing dental extractions, resulting in a reduction in the average preoperative international normalized ratio (INR) from 2.8 to 1.6. The study group of 30 patients received the anticoagulant drug without any alteration before extractions and had an average preoperative INR of 2.7. All extractions were done under local anesthesia on an outpatient basis, and local measures consisting of gelfoam and sutures were used in all cases to control postoperative bleeding from extraction sockets. None of the patients had any immediate postoperative bleeding, and only one patient from the control group and two patients from the study group had mild delayed hemorrhage which was easily managed with local measures. There is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0-4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.