Tooth extraction for patient undergoing warfarin treatment: A case report

Main Article Content

Supicha Tangpiboontam

Abstract

A 65-year-old Thai male patient with HT, Ishemic stroke and prosthetic heart valve on warfarin had an International Normalized Ratio (INR) of 3.18 He was able to safety undergo simple extraction of single tooth, suturing and local hemostats without postoperative bleeding and needing to stop his warfarin treatment or reduce the dosage.


           Although it is currently recommended that tooth extraction in patient receiving continuous anticoagulants be combined with local hemostasis without stop taking the medication prior procedure to prevent thrombosis, most dentists recommend consulting with the family physician to consider stopping or reducing the medication prior to tooth extraction.


This report demonstrates and encourages dentists to safety perform minor dental procedures with low bleeding risk and local hemostats in patient receiving medication without discontinuation  or adjustment of drug prior to tooth extraction.


 

Article Details

How to Cite
1.
Tangpiboontam S. Tooth extraction for patient undergoing warfarin treatment: A case report. Kb. Med. J. [internet]. 2025 Jul. 30 [cited 2026 Jan. 12];8(1):129-36. available from: https://he01.tci-thaijo.org/index.php/KBJ/article/view/281502
Section
Case Report

References

Fuster V, O’Rourke R. Hurst’s the heart. 12th ed. New York: McGraw-Hill Medical; 2008.

Kirchhof P, Benussi S, Kotecha D. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the task force for the management of atrial fibrillation of European Society of Cardiology (ESC). Eur Heart J 2016;37:2893-962.

Gurbel PA, Myat A, Kubica J, Tantry US. State of the art: Oral antiplatelet Therapy. JRSM Cardiovasc Dis 2106;5:2048004016652514.

Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, van Walraven C. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ 2008;179:235-44.

Lusk KA, Snoga JL, Benitez RM, Sarbacker GB. Management of Anticoagulants Surrounding Dental Procedures with Low-to-Moderate Risk of Bleeding. J Pharm Pract 2018;31(2):202-7.

Blacker DJ, Wijdicks FM, McClelland RL. Stroke risk in anticoagulated patient with atrial fibrillation undergoing endoscopy. Neurology 2003;61(7):964-8.

Morimoto Y, Niwa H, Minematsu K. Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg 2008;66:51-7.

Devani P, Lavery KM, Howett CJT. Dental extractions in patients on warfarin: is alteration of anticoagulant regimen necessary? Br J Oral Maxillofac Surg 1998;36:17-11.

http://www.ada.org/en/member-center/oral-health-topics/anticoagulant-antiplatelet-medications-and-dental-procedures2018.

Ministry of Public Health. Clinical Practice Guideline (cited 2024 Dec 30); 1(30 screens). Available from:http://cloud-atg.moph.go.th.

http://www.ada.org/en/library and archieves/community initiative 2022.

Chiewwit N, Chokchaivorakul W, Nissapa K. Postoperative bleeding after dental procedures in patients taking continuously antithrombotic drugs compared with interrupted antithrombotic drugs: A retrospective non-inferiority study. J Dent Assoc Thai 2022;72(4):551-66.

Lee JK. Dental management of patient on anti-thrombotic agents. J Korean Assoc Oral Maxillofac Surg 2108;44(4):143-50.

Morimoto Y, Niwa H, Minematsu K. Risk factors affecting postoperative hemorrhage after tooth extraction in patients recieving oral antithrombotic therapy. J Oral Maxillofac Surg 2011;69:1550-6.

Perry DJ, Noakes TJ, Helliwell PS, British Dental Society. Guidelines for patients on oral anticoagulants requiring dental surgery. Br Dent J 2007;203(7):389-93.

Carter G, Goss A. Tranexamic acid mouthwash-a prospective randomized study of 2-day regimen vs –day regimen to prevent postoperative bleeding in anticoagulated patients requiring dental extractions. Int J Oral Maxillofac Surg 2003;32:504-7.