Hemostatic management of tooth extractions in patients on oral antithrombotic therapy

We examined hemostatic management for tooth extraction in patients maintained on oral antithrombotic therapy.

Subjects comprised 270 patients, with 134 receiving warfarin alone, 49 receiving warfarin with additional antiplatelet drugs, and the remaining 87 receiving antiplatelet drugs alone. In patients administered warfarin alone, international normalized ratio (INR) was 1.5 to 1.99 in 67 patients, 2.0 to 2.49 in 42, 2.5 to 2.99 in 21, and 3.0 to 3.7 in 4. A total of 513 teeth were extracted on 306 occasions. All teeth were extracted without reducing the usual antithrombotic therapy, and oxidized cellulose was applied and suturing was performed for local hemostasis.

Postoperative hemorrhage occurred in 11 of 306 occasions of tooth extractions (3.6%). These involved 7 patients on warfarin monotherapy and 2 on combination therapy with warfarin and antiplatelet drugs, with INR between 1.50 and 2.49. Incidence of postoperative hemorrhage was unrelated to INR, and no significant differences were identified between warfarin monotherapy and combination therapy. The remaining 2 patients who experienced hemorrhage were administered antiplatelet drugs alone.

A sufficient hemostasis can be obtained in most cases of tooth extraction under anticoagulant therapy with warfarin (INR <3.0) and antiplatelet drugs. Moreover, appropriate local hemostatic methods can be successful when postoperative hemorrhage occurs.