Abstract

Objectives 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 <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls.

Conclusion Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.

1. Dental Department, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
2. Dental Department, Armed Forces Hospital, Riyadh, Saudi Arabia
3. Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies, Riyadh, Saudi Arabia
4. Dental Department, Armed Forces Hospital, Riyadh, Saudi Arabia
5. Research Center, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
6. Dental Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia;
7. Dental Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
8. Department of Periodontics and Endodontics, School of Dental Medicine, State University of New York at Buffalo, New York, USA

Correspondence to: S. Al-Mubarak¹ Consultant Periodontist, Chairman of Dental Department, Chairman of Research and Ethics Committee, P.O. Box 64399, Riyadh 11536, Saudi Arabia
e-mail: smubarak@humanitariancity.org.sa