OBJECTIVES: To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions. METHODS:Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7). RESULTS: Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls. CONCLUSION:Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.
RCT Entities:
OBJECTIVES: To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions. METHODS: Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7). RESULTS: Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls. CONCLUSION: Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.
Authors: Thayanne Barbosa Brasil Calcia; Harry Juan Rivera Oballe; Alice Maria de Oliveira Silva; Stephanie Anagnostopoulos Friedrich; Francisco Wilker Mustafa Gomes Muniz Journal: Clin Oral Investig Date: 2021-03-23 Impact factor: 3.573
Authors: Rogério Heládio Lopes Motta; Cristiane de Cássia Bergamaschi; Natalia Karol de Andrade; Caio Chaves Guimaraes; Juliana Cama Ramacciato; Jimmy de Oliveira Araújo; Luciane Cruz Lopes Journal: BMJ Open Date: 2017-12-19 Impact factor: 2.692