Oral Surgery & Warfarin
The risk of significant bleeding in patients on Warfarin
is low.

Patients on Warfarin might bleed more than normal but
bleeding is easily treated with 'local measures' (packing the
tooth-socket with material that aids blood-clotting and
stitching of the tooth socket).

Warfarin should
NOT be discontinued in the majority of
patients requiring dental extractions and biopsies unless
instructed otherwise by their
Anticoagulant Clinic.

There is an increased risk of
thrombosis in patients who
have temporarily stopped taking their
Warfarin (the risk is
small but potentially fatal).  Bleeding complications, while
inconvenient, do not carry the same risks as
complications (that can lead to permanent
disability or death).
Treatment Algorithm for Warfarinised Patients (British Dental Journal 2003)
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Last Updated 5th May 2016
List of Drugs that Interact with Warfarin
Useful Websites:

British Committee for Standards in Haematology

Queen Victoria Hospital OMFS Department, East Grinstead

NHS Evidence - Oral Health

Useful Articles:

North West Medicines Information Centre 2001.  Surgical Management Of The
Primary Care Dental Patient On Warfarin

British Dental Journal 2003.  Dental management considerations for the patient
with an acquired coagulopathy.  Part 2.  Coagulopathies from Drugs

Austral Dental J 2003.  Current Concepts of the Management of Dental Extractions
for Patients taking Warfarin

BDJ 2003.  Antibacterial Prescribing & Warfarin.  A Review

BDJ 2003.  Dental Management Considerations for the Patient with an Acquired
Coagulopathy.  Part 2. Coagulopathies from Drugs

Dental Update 2004.  Management of Dental Patients on Warfarin Therapy in a
Primary Care Setting

American Academy of Oral Medicine 2007. Patient Information Sheet.  Blood
Thinners Dental Care

J Oral Sciences 2007.  Dental Management of patients recieving anti-coagulation
or anti-platelet treatment

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007.  Management of Dental
Patients taking Common Hemostasis-Altering Medications

Evidence-Based Dentistry 2008.  Guidelines for the Management of Patients who
are taking Oral Anticoagulants & who require Dental Surgery

Evidence-Based Dentistry 2009.  Continuing Warfarin Therapy does not Increased
Risk of Bleeding for Patients undergoing Minor Dental Procedures

JOMS 2011.  Comparison of the Effects of Warfarin & Heparin on Bleeding
Caused by Dental Extraction.  A Clinical Study

JOMS 2011.  Delayed Complications of Tooth Extraction in Patients Taking
Warfarin, Antibiotics and Other Medications

JOMS 2011.  Risk Factors Affecting Postoperative Hemorrhage After Tooth
Extraction in Patients Receiving Oral Antithrombotic Therapy

Dental Update 2012.  An Interesting Potential Reaction to Warfarin

Dental Update 2012.  Bleeding Disorders seen in the Dental Practice

Dental Update 2012.  Management of Bleeding Disorders in the Dental Practice -
Managing Patients on Anticoagulants

BJOMS 2012.  Safety of local anaesthesia in dental patients taking oral
anticoagulants.  Is it still controversial

Dent Update 2013. Special Care Dentistry Part 2.  Dental Management of Patients
with Drug-Related Acquired Bleeding Disorders

Dent Update 2016. Warfarin and Drug Interactions - Prescribing Vigilance
Ideally, the INR should be checked within 36 hours of the procedure.  If the INR is
below 4.0, then the procedure can go ahead.

How Should Post-Operative Pain Be Managed?

Patients should follow the advice of their Anticoagulant Clinic with regard to the
choice of painkillers for short-term, mild to moderate pain.

Paracetamol is considered the safest simple painkiller for patients
Warfarin and it may be taken in normal doses if pain control is needed and
no contra-indication exists.

Patients should not to take
Aspirin, Aspirin-containing compound preparations or
Non-Steroidal Anti-Inflammatory Drugs e.g. Ibuprofen, which are considered less
safe than
Paracetamol in patients taking Warfarin.

Patients requiring a course of antibiotics post-operatively should be vigilant for any
signs of increased bleeding.