Many patients taking warfarin (Coumadin) can undergo a dental extraction while maintaining their level of anticoagulation.


INR Prior to Procedure


< 4

Proceed with dental extraction.

>= 4

The INR should be reduced to the therapeutic range before proceeding with the extraction.


The incidence of bleeding after an extraction for a patient taking an oral anticoagulant was slightly higher than if warfarin was discontinued in advance. Just over 90% of bleeding episodes in one study was minor and controlled by biting on a gauze square.


If bleeding is uncontrolled then the extraction socket can be treated.


It is important to determine if the patient has other risk factors for bleeding such as thrombocytopenia, antiplatelet drug exposure, etc. Management of these patients may be more complicated.


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