A clinical study of hemorrhagic complications in patients with antithrombotic therapy who underwent dental extraction without discontinuation of antithrombotic drugs

—282 patients receiving administration of warfarin—

Abstract

It has been recommended recently that patients receiving anticoagulant therapy should undergo dental extraction without discontinuation of anticoagulant drugs in consideration of the risk of thromboembolism, but the frequency of hemorrhagic complications has not been well documented. A retrospective study of 282 patients who underwent dental extraction under continuous warfarin therapy was performed.
Twenty-two of the 282 patients (8.9%) showed postoperative hemorrhages: 14 of 168 (8.3%) in those receiving administration of warfarin alone, and 11 of 114 (9.6%) in those receiving administration of both warfarin and antiplatelet drugs. Most of the hemorrhages occurred within 2 days after the extraction. The rate of postoperative hemorrhage was 5.7% in those with prothrombin time International Normalized Ratio (PT-INR) of 1.49 or lower, 12.5% in those with PT-INR of 1.5-1.99, 12.8% in those with PT-INR of 2.0-2.99, and 16.7% in those with PT-INR of 3.0 or higher, although there was no significant difference between PT-INR and frequency of postoperative hemorrhage. All patients showing postoperative hemorrhage were treated successfully by local procedures such as suturing or application of cellulose oxide gauze. These findings suggest that dental extraction can be safely done without discontinuation of warfarin therapy.