The risk of significant bleeding in patients on Warfarin
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 thrombo-
embolic 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
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.
Generally, Paracetamol is considered the safest simple painkiller for patients
taking 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.