Summary trial/Oral Surgery
Evidence-Based Dentistry (2007) 9, 7. doi:10.1038/sj.ebd.6400559
Suturing extraction sockets on patients maintained on oral anticoagulants
Is suturing necessary after dental extractions when patients temporarily discontinue their anticoagulant therapy?
Address for correspondence: Dr Sultan Al-Mubarak, Consultant Periodontist, PO Box 64399, Riyadh 11536, Saudi Arabia. E-mail: smubarak@humanitariancity.org.sa
Cameron Walker1
1Glasgow Dental Hospital and School, Glasgow, Scotland, UK
Al-Mubarak S, Al-Ali N, Rass MA, et al. Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy. Br Dent J 2007; vol:203. Epub 2007 Aug 10.
Abstract
Design
A randomised controlled trial (RCT) was carried out.
Intervention
Patients scheduled for dental extraction were randomly divided into four groups: no suturing with either discontinued anticoagulants (group 1) or continued warfarin (group 2); and suturing with either discontinued anticoagulants (group 3) or continued warfarin (group 4). The international normalised ratio (INR) was determined at different timepoints (baseline, days 1, 3 and 7).
Outcome measure
The status of bleeding and healing were assessed by an independent examiner blinded to the treatment protocol for the four treatment groups.
Results
Discontinuing warfarin reduced INR level significantly at day 1, and it subsequently reached <1.5 in 96 out of 104 patients (groups 1 and 3). Statistical comparisons between the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed a higher but insignificant incidence of bleeding postoperatively compared with their respective controls.
Conclusions
Dental extractions may be safely performed for people who are taking 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 a case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in some situations, such as simple extractions.
