Postoperative bleeding and oral anticoagulants

Key Points Dental extractions can be safely performed on patients receiving warfarin therapy without stopping or altering the dose of anticoagulant. The chances of a thromboembolic attack may be significantly higher than the chance of postoperative bleeding when anticoagulant medication is temporarily stopped. Mechanical pressure may be very important and beneficial in stopping postoperative bleeding compared with other alternatives. Objective To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions. Methods Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7). Results Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached