No need to routinely discontinue anticoagulants before dental extractions

Abstract

Question: In patients who need anticoagulant therapy and require dental extraction, is it safe to continue with anticoagulation? Aim To investigate whether people taking warfarin with an international normalised ratio (INR) within the normal therapeutic range require anticoagulants to be stopped before dental extractions. Design Randomised controlled trial of 117 patients in a hospital environment. Intervention The control group stopped taking warfarin 2 days before extraction if the INR was >2 and the procedure was rebooked for following day. The intervention group continued to take medication. If the INR was >4 on the day of the procedure the patient was withdrawn. The use of tranexamic acid mouth-rinse was not permitted. Extractions were performed under local anaesthetic using as atraumatic a technique as possible. Outcome measure Clinical notes and patient logbooks were used to record any complications. Results The rate of bleeding complications was higher in the group continuing with anticoagulation but the difference was not significant. Conclusions The study shows that dental extractions can be carried out safely in a hospital without stopping anticoagulation if the patient's INR is <4.1. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofacial Surg 2002; 40:248–242