Continuing warfarin therapy does not increased risk of bleeding for patients undergoing minor dental procedures

Medline, Embase, Cochrane Central Register of Controlled Trials, International Association for Dental Research abstracts and reference lists of retrieved articles were searched, and contact made with content experts.

Studies were selected independently by two reviewers. Randomised controlled trials (RCT) were selected if: they compared the effects of continuing a regular dose of warfarin with the effects of discontinuing (or modifying) the dose on the incidence of bleeding; the study group participants were people undergoing dental procedures who also had thromboembolism (arterial or venous); and the outcome assessed was postoperative bleeding (major, clinically significant nonmajor, or minor). Study quality was assessed using the Jadad scale.

Data extraction was carried out by three reviewers independently. Meta-analysis was conducted using a random-effects model.

Five RCT (553 patients) met the inclusion criteria. Compared with interrupting warfarin therapy (either partial or complete), peri-operative continuation of warfarin at the patient's usual dose was not associated with an increased risk for clinically significant nonmajor bleeding [relative risk (RR), 0.71; 95% confidence interval (CI), 0.39-1.28; P 0.65; I(2) 0%) or an increased risk for minor bleeding (RR, 1.19; 95% CI, 0.90-1.58; P 0.22; I(2) 0%).

Continuing the regular dose of warfarin therapy does not seem to confer an increased risk of bleeding compared with discontinuing or modifying the warfarin dose in people undergoing minor dental procedures.