Bleeding after dental extractions in patients taking warfarin

Objective To assess the incidence of bleeding after dental extractions in subjects taking warfarin continuously before and after extractions whose International Normalised Ratio (INR) was below 4.0 at the time of extraction. Methods This was a case series study of 150 patients without controls who required extraction of at least one tooth under local anaesthetic. All sockets were subsequently packed with absorbable oxycellulose and sutured. Results A total of 58 women and 92 men were included (mean age 66 years); their ages were similar. The mean INR (S.D.) was 2.5 (0.56), although most patients had an INR less than 2.5 (n = 101). Ten patients (7%) bled after extraction, enough to require a return to hospital. Five patients of 101 with an INR ≤ 2.5, and 5 with an INR > 2.5 out of 49 bled after extraction (p = 0.29). Bleeding after extraction was not associated with operative antibiotics. All patients who bled were managed conservatively and none was admitted to hospital. Conclusion Patients taking warfarin whose INR is up to 4.0 and who have dental extractions in hospital do not have clinically significant bleeds post-operatively.