Surgical management of the primary care dental patient on warfarin

The management of anti-coagulated dental patients in primary care has changed over the last decade. There is now considerable evidence that many patients can safely be managed without stopping or altering their warfarin. This paper summarizes the evidence and provides guidance for the dentist on identifying which patients can be managed in primary care. Generally, such patients are those with a stable INR within the therapeutic range, between 2.0 and 4.0, undergoing simple extractions, scaling and minor surgical procedures, for whom local haemostatic measures are used, including packing with a haemostatic dressing, suturing and application of local pressure. Management advice is presented in the form of an algorithm providing additional information on postoperative care.

Dental practitioners in primary care treat an increasing number of patients taking warfarin, so identification of patients who may be treated is of importance.