Dental implications of warfarin therapy

Editor, – We wish to comment on the dental implications of warfarin therapy as discussed by Professor R. Woods (Aust Prescr 1998;21:12).

We agree that there is little need to modify anticoagulant therapy for most routine dental treatment, but in procedures that are likely to cause significant bleeding, patient management may need to be changed.

We draw your readers' attention to a paper published in 1989.1 In this, they describe the safety and efficacy of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. We followed up their observations with a report confirming these findings.2 Our recommendation was that, for simple extractions, patients continue on their stable dose of warfarin and are given tranexamic acid mouthwash without interruption of their anticoagulant therapy. For more extensive surgery, we have ceased warfarin for up to 4-5 nights before the procedure and recommenced it on the evening of the procedure if the bleeding has been locally controlled. It is critical that excellent haemostasis is ensured at the time of dental surgery including the use of sealants and suturing.

We prescribed tranexamic acid as a 5% solution with 10 mL to be held in the mouth for two minutes 5 times/day for up to 7 days.

The use of oral tranexamic acid has revolutionised the dental management of patients on oral anticoagulants and is also useful in the oral medical management of patients with other bleeding disorders such as haemophilia and thrombocytopenia.

Associate Professor A. Street
Head, Haematology Unit


Dr W. Leung
Oral Surgeon, Dental Clinic
Alfred Hospital
Melbourne, Vic.