Dental extractions in patients on warfarin

for patients awaiting elective dental procedures who are taking warfarin for a limited period (e.g. 6 months for a DVT) then the procedure should be postponed until the warfarin has been stopped

• for patients on long-term warfarin treatment (e.g. atrial fibrillation, recurrent venous thromboembolism, mechanical heart valves) then the UK Medicines Information (UKMI) says that warfarin does not need to be stopped before primary dental procedures (although the continuation of warfarin treatment increases the risk of bleeding, the risk appears to be minimal)

• an INR should be measured within 24 hours of undertaking the procedure

• the UKMI recommend that no individual should have an dental procedure in primary care if an INR > 4.0 - however British Haematological Society guidelines recommend that the INR should be no greater than two at the time of the procedure (2)

• UKMI also recommend that warfarin patients with renal or hepatic disease or those on chemotherapy or cytotoxics should have dental procedures in hospital

Reference:

1. Pulse (2004), 64 (7), 83.
2. MeReC Bulletin (1997), 8(1), 1-4.