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This guideline is especially helpful in my daily management of patients. [1] Patients taking warfarin come to my clinic to obtain referrals for dental extraction because most dental surgeons in Malaysia refuse to perform dental procedures without clearance. I agree with the continuation of warfarin during dental procedures but certain precautions should be taken. Oral surgery may be completed safely at INR of 1.5-2.5 [2] and up to INR 4 for a small procedure. [3] The INR should be checked prior to surgery. For simple extractions, bleeding should be controlled by minimizing surgery to only one site and post-operative packs or firm sutures should cover the wound. Local anesthetic should be given cautiously to avoid venepunctures. [4] I hope a future guideline will address novel anticoagulant therapy for use during dental procedures.
1. Melissa J. Armstrong, Gary Gronseth, David C. Anderson Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology
2.Little JW, Falace DA, Miller CS et al. Dental management of medically compromised patient. 5th ed. St. Louis: Mosby; 1997
3.Devani P, Lavary KM, Howell CJ. Dental extraction in patient on warfarin: is alteration of anticoagulant necessary? Br J Oral Maxillofac Surg 1998; 36:107-111
4.Savage N. Managing dental patients receiving warfarin therapy. Aust Prescr 2002; 25:69
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