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Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Feb;119(2):136-57. doi: 10.1016/j.oooo.2014.10.011. Epub 2014 Nov 13.

Dental surgery in anticoagulated patients--stop the interruption.

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Christiana Care Health System, Wilmington, Delaware, USA. Electronic address:
University Hospitals Case Medical Center and Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
Public Services Librarian, Edward and Barbara Netter Library, Quinnipiac University, Hamden, Connecticut, USA.
Section of Oral Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.


In a literature review, the incidence and morbidity of bleeding complications after dental surgery in anticoagulated patients was compared with embolic complications when anticoagulation was interrupted. Over 99% of anticoagulated patients had no postoperative bleeding that required more than local hemostatic measures. Of more than 5431 patients undergoing more than 11,381 surgical procedures, with many patients at higher than present therapeutic intenational normalized ratio (INR) levels, only 31 (∼0.6% of patients) required more than local hemostasis to control the hemorrhage; none died due to hemorrhage. Among at least 2673 patients whose warfarin dose was reduced or withdrawn for at least 2775 visits for dental procedures, there were 22 embolic complications (0.8% of cessations), including 6 fatal events (0.2% of cessations). The embolic morbidity risk in patients whose anticoagulation is interrupted for dental surgery exceeds that of significant bleeding complications in patients whose anticoagulation is continued, even when surgery is extensive. Warfarin anticoagulation, therefore, should not be interrupted for most dental surgery.

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