J Korean Assoc Oral Maxillofac Surg.  2020 Aug;46(4):228-234. 10.5125/jkaoms.2020.46.4.228.

Effect of warfarin discontinuation on the incidence of postoperative bleeding in tooth extraction

• Lee JS
• Kim MK
• Kang SH

• KMID: 2505436
• DOI: http://doi.org/10.5125/jkaoms.2020.46.4.228

Abstract

Objectives
The number of patients undergoing oral anticoagulant therapy for cardiovascular and cerebrovascular disease is increasing. However, the risk of bleeding after tooth extraction in patients receiving warfarin is unclear. Here, we assess the risk of bleeding after tooth extraction in patients on warfarin.
Materials and Methods
The study included 260 patients taking warfarin who underwent tooth extraction (694 teeth). The patients were divided into those whose teeth were extracted while they were taking warfarin, those who discontinued warfarin before extraction, and those who underwent extraction while receiving heparin bridging therapy. Bleeding complications in the two groups were compared.
Results
Of the 260 patients, 156 underwent extraction while taking warfarin, 70 stopped taking warfarin before extractions, and 34 received heparin bridging therapy and stopped taking either medication before extractions. Bleeding complications occurred in 9 patients (3.5%) and 9 tooth sites (1.3%). Among the 9 patients with bleeding complications, 6 underwent extraction while taking warfarin, 2 stopped warfarin before extraction, and 1 underwent extraction after receiving heparin bridging therapy. No significant difference was seen between patient groups regarding bleeding after extractions (p=0.917).
Conclusion
Warfarin use does not increase the risk of post-extraction bleeding and can therefore be continued during tooth extraction.

Keyword

Bleeding; Tooth extraction; Warfarin

Reference

References

1. Dudek D, Marchionni S, Gabriele M, Iurlaro A, Helewski K, Toti P, et al. 2016; Bleeding rate after tooth extraction in patients under oral anticoagulant therapy. J Craniofac Surg. 27:1228–33. https://doi.org/10.1097/SCS.0000000000002713 . DOI: 10.1097/SCS.0000000000002713. PMID: 27380567.

2. Bajkin BV, Popovic SL, Selakovic SD. 2009; Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg. 67:990–5. https://doi.org/10.1016/j.joms.2008.12.027 . DOI: 10.1016/j.joms.2008.12.027. PMID: 19375008.

3. Garcia DA, Regan S, Henault LE, Upadhyay A, Baker J, Othman M, et al. 2008; Risk of thromboembolism with short-term interruption of warfarin therapy. Arch Intern Med. 168:63–9. https://doi.org/10.1001/archinternmed.2007.23 . DOI: 10.1001/archinternmed.2007.23. PMID: 18195197.

4. Chahine J, Khoudary MN, Nasr S. 2019; Anticoagulation use prior to common dental procedures: a systematic review. Cardiol Res Pract. 2019:9308631. https://doi.org/10.1155/2019/9308631 . DOI: 10.1155/2019/9308631. PMID: 31275643. PMCID: PMC6589257.

5. Bajkin BV, Vujkov SB, Milekic BR, Vuckovic BA. 2015; Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. J Am Dent Assoc. 146:375–81. https://doi.org/10.1016/j.adaj.2015.01.017 . DOI: 10.1016/j.adaj.2015.01.017. PMID: 26025824.

6. Svensson R, Hallmer F, Englesson CS, Svensson PJ, Becktor JP. 2013; Treatment with local hemostatic agents and primary closure after tooth extraction in warfarin treated patients. Swed Dent J. 37:71–7. PMID: 23957141.

7. Yoshikawa H, Yoshida M, Yasaka M, Yoshida H, Murasato Y, Fukunaga D, et al. 2019; Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study. Int J Oral Maxillofac Surg. 48:1102–8. https://doi.org/10.1016/j.ijom.2019.01.013 . DOI: 10.1016/j.ijom.2019.01.013. PMID: 30745243.

8. Yagyuu T, Kawakami M, Ueyama Y, Imada M, Kurihara M, Matsusue Y, et al. 2017; Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study. BMJ Open. 7:e015952. discussion 410-1. https://doi.org/10.1136/bmjopen-2017-015952 . DOI: 10.1136/bmjopen-2017-015952. PMID: 28827248. PMCID: PMC5629650.

9. Rocha AL, Oliveira SR, Souza AF, Travassos DV, Abreu LG, Ribeiro DD, et al. 2019; Bleeding assessment in oral surgery: a cohort study comparing individuals on anticoagulant therapy and a non-anticoagulated group. J Craniomaxillofac Surg. 47:798–804. https://doi.org/10.1016/j.jcms.2019.01.049 . DOI: 10.1016/j.jcms.2019.01.049. PMID: 30792032.

10. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. 2002; Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 40:248–52. https://doi.org/10.1054/bjom.2001.0773 . DOI: 10.1054/bjom.2001.0773. PMID: 12054719.

11. Al-Mubarak S, Al-Ali N, Abou-Rass M, Al-Sohail A, Robert A, Al-Zoman K, et al. 2007; Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J. 203:E15. https://doi.org/10.1038/bdj.2007.725 . DOI: 10.1038/bdj.2007.725. PMID: 17694045.

12. Yang S, Shi Q, Liu J, Li J, Xu J. 2016; Should oral anticoagulant therapy be continued during dental extraction? A meta-analysis. BMC Oral Health. 16:81. https://doi.org/10.1186/s12903-016-0278-9 . DOI: 10.1186/s12903-016-0278-9. PMID: 27566540. PMCID: PMC5002166.

13. Scully C, Wolff A. 2002; Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 94:57–64. https://doi.org/10.1067/moe.2002.123828 . DOI: 10.1067/moe.2002.123828. PMID: 12193895.

14. Schulman S, Henriksson K. 1989; Interaction of ibuprofen and warfarin on primary haemostasis. Br J Rheumatol. 28:46–9. https://doi.org/10.1093/rheumatology/28.1.46 . DOI: 10.1093/rheumatology/28.1.46. PMID: 2783873.

15. Febbo A, Cheng A, Stein B, Goss A, Sambrook P. 2016; Postoperative bleeding following dental extractions in patients anticoagulated with warfarin. J Oral Maxillofac Surg. 74:1518–23. https://doi.org/10.1016/j.joms.2016.04.007 . DOI: 10.1016/j.joms.2016.04.007. PMID: 27186873.