Oral Surgery & Warfarin
The risk of significant bleeding in patients on Warfarin is low.
Patients on Warfarin might bleed more than normal but bleeding is easily treated with ‘local measures’ (packing the tooth-socket with material that aids blood-clotting and stitching of the tooth socket).
Warfarin should NOT be discontinued in the majority of patients requiring dental extractions and biopsies unless instructed otherwise by their Anticoagulant Clinic.
There is an increased risk of thrombosis in patients who have temporarily stopped taking their Warfarin (the risk is small but potentially fatal). Bleeding complications, while inconvenient, do not carry the same risks as thrombo-embolic complications (that can lead to permanent disability or death).
Ideally, the INR should be checked within 36 hours of the procedure. If the INR is below 4.0, then the procedure can go ahead.
How Should Post-Operative Pain Be Managed?
Patients should follow the advice of their Anticoagulant Clinic with regard to the choice of painkillers for short-term, mild to moderate pain.
Generally, Paracetamol is considered the safest simple painkiller for patients taking Warfarin and it may be taken in normal doses if pain control is needed and no contra-indication exists.
Patients should not to take Aspirin, Aspirin-containing compound preparations or Non-Steroidal Anti-Inflammatory Drugs e.g. Ibuprofen, which are considered less safe than Paracetamol in patients taking Warfarin.
Patients requiring a course of antibiotics post-operatively should be vigilant for any signs of increased bleeding.