The risk of significant bleeding in patients on Warfarin
and with a stable INR in the therapeutic range 2 – 4, is
low.
Patients on Warfarin might bleed more than normal but
bleeding is easily treated with ‘local measures’ (packing the
tooth-socket with material that aids blood-clotting and
stitching of the tooth socket).
Warfarin should NOT be discontinued in the majority of
patients requiring dental extractions and biopsies unless
instructed otherwise by their Anticoagulant Clinic.
There is an increased risk of thrombosis in patients who
have temporarily stopped taking their Warfarin (the risk is
small but potentially fatal). Bleeding complications, while
inconvenient, do not carry the same risks as thrombo-
embolic complications (that can lead to permanent
disability or death).
Pre-Operative Management
Ideally, the INR should be checked within 36 hours of the
procedure. If the INR is below 4.0, then the procedure can
go ahead.
How Should Post-Operative Pain Be Managed?
Patients should follow the advice of their Anticoagulant
Clinic with regard to the choice of painkillers for
short-term, mild to moderate pain.
Generally, Paracetamol is considered the safest simple
painkiller for patients taking Warfarin and it may be taken
in normal doses if pain control is needed and no
contra-indication exists.
Patients should not to take Aspirin, Aspirin-containing
compound preparations or Non-Steroidal
Anti-Inflammatory Drugs e.g. Ibuprofen, which are
considered less safe than Paracetamol in patients taking
Warfarin.
Patients requiring a course of antibiotics post-operatively
should be vigilant for any signs of increased bleeding.
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