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Letter to the editor

Editor, -The management of patients taking anticoagulants who require dental extractions is of interest to both medical and dental practitioners.1 It has been common practice to discontinue anticoagulants to reduce the risk of post-extraction bleeding. Lately however some studies have questioned the need for reduction or withdrawal of warfarin when the INR was within the therapeutic range.

We have recently reported a study involving 70 patients who were taking warfarin for a variety of medical conditions and required dental surgery.2 A control group of 35 patients stopped their warfarin before their minor oral surgery while the other patients continued treatment (INR 2-4). Local haemostatic measures were only used when the procedure involved removal of bone or soft tissue surgery.

There was no significant post-treatment haemorrhage in either group. This suggests that patients can safely undergo minor oral surgical procedures without alteration to their therapeutic anticoagulant regimen. This reduces the risk of thromboembolic episodes occurring when the warfarin is stopped.

Peter D Cannon
Oral and maxillofacial surgeon
Canberra Surgicentre Braddon, ACT
and
Vandna T Dharmar
Huddersfield, UK

References

  1. Woods R. Managing dental patients receiving warfarin. Aust Prescr 2002;25:69 .
  2. Cannon PD, Dharmar VT. Minor oral surgical procedures in patients on oral anticoagulants - a controlled study. Aust Dent J 2003;48:115-8. .