Oral Surgery & Warfarin
The risk of significant bleeding in patients on Warfarin and
with a stable
INR in the therapeutic range 2 - 4, is low.

Patients on
Warfarin might bleed more than normal but
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).

Pre-Operative Management

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
with regard to the choice of painkillers for
short-term, mild to moderate pain.

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
Anti-Inflammatory Drugs
e.g. Ibuprofen, which are
considered less safe than
Paracetamol in patients taking

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

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

British Dental Journal 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
Treatment Algorithm for Warfarinised Patients
(British Dental Journal 2003)
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Last Updated 11th August 2010