Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated with Warfarin

Publication date: Available online 22 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anthony Febbo, Andrew Cheng, Brian Stein, Alastair Goss, Paul Sambrook
PurposeThe practising dentist must frequently advise on the risks involved with dental extractions in the anticoagulated patient. We aimed to assess the risk of bleeding in a large heterogeneous cohort of patients on warfarin treated by practitioners in training (dental students and junior staff in a teaching hospital).MethodsA retrospective case-control study of 439 anticoagulated cases on warfarin (1022 extractions) and 439 matched controls (1049 extractions). Patients with INR<2.2 had no specific measures, INR 2.2-4 sutured and tranexamic acid mouthwash, INR>4 no extraction. Bayesian methods were used to estimate posterior probabilities of bleeding.ResultsCases were 63% male, 25% were over 80, 40% had an INR<2.2 and 9% had an INR>3. Nine cases bled 0-10 days postoperatively, with one requiring admission and transfusion. Significant predictors of bleeding were INR and number of extractions (p<0.001 for both). There were no events of bleeding in controls or cases with an INR<2.2 (95% credible interval (CrI) for difference -0.7-1.6%). The posterior mean of bleeding was 1% (CrI 0.1-2.6%) for INR<2.2, 2.3% (CrI 0.9-4.5%) for INR 2.2-3 and 8.4% (CrI 3.5-15%) for INR>3.ConclusionUnselected anticoagulated patients with an INR<2.2 have a similar risk of bleeding to control patients. The risk is about 1/40 in those with an INR 2.2-3 while the risk in patients with an INR>3 is about 1 in 11.



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