Abdullah Walid Ahmed, Khalil Hesham
Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia ; Department of Oral and Maxillofacial Surgery, College of Dentistry, Mansoura University, Mansoura, Egypt.
Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Clin Cosmet Investig Dent. 2014 Aug 19;6:65-9. doi: 10.2147/CCIDE.S68641. eCollection 2014.
Warfarin is one of the most common oral anticoagulants used to prevent thromboembolic episodes. The benefits of discontinuation of this drug before simple surgical procedures are not clear and this approach could be associated with complications. The aim of this study was to evaluate the risk of bleeding in a series of 35 patients (in cases where the international normalized ratio [INR] is less than 4) following simple tooth extraction without modification of the warfarin dose given to patients.
Thirty-five patients taking warfarin who had been referred to the Oral and Maxillofacial Department, College of Dentistry, King Saud University, for dental extractions were included in the study. Exclusion criteria included patients with an INR of ≥4 or with a history of liver disease or coagulopathies. No alteration was made in warfarin dose, and the CoaguChek System was used to identify the INR on the same day of dental extraction. Bleeding from the extraction site was evaluated and recorded immediately after extraction until the second day.
A total of 35 patients (16 women and 19 men) aged between 38 and 57 years (mean =48.7) were included in the present study. All patients underwent simple one-tooth extraction while undergoing warfarin treatment. Oozing, considered mild bleeding and which did not need intervention was seen in 88.6% of patients. Moderate bleeding occurred in 11.4% of all cases. The INR of the patients ranged from 2.00 to 3.50, with 77.2% of patients having INR between 2.0 and 2.5 on the day of extraction. No severe bleeding which needed hospital management was encountered after any of the extractions. The patients who suffered moderate bleeding were returned to the clinic where they received local treatment measures to control bleeding. Moderate bleeding occurred only in four patients, where three had INR between 3.1 and 3.5, and one with INR less than 3.
In the present study, we have shown that simple tooth extraction in patients on warfarin treatment can be performed safely without high risk of bleeding, providing that the INR is equal or less than 3.5 on the day of extraction. A close follow-up and monitoring of patients taking warfarin is mandatory after dental extraction.
华法林是用于预防血栓栓塞事件的最常用口服抗凝剂之一。在简单外科手术前停用该药物的益处尚不清楚，且这种做法可能会引发并发症。本研究的目的是评估35例患者（国际标准化比值[INR]小于4）在未调整华法林剂量的情况下进行简单拔牙后出血的风险。
本研究纳入了35例服用华法林且因拔牙转诊至沙特国王大学牙科学院口腔颌面科的患者。排除标准包括INR≥4或有肝病或凝血障碍病史的患者。华法林剂量未作改变，在拔牙当天使用CoaguChek系统测定INR。拔牙后立即评估并记录拔牙部位的出血情况，直至第二天。
本研究共纳入35例患者（16例女性和19例男性），年龄在38至57岁之间（平均48.7岁）。所有患者在接受华法林治疗期间均接受了简单的单颗牙拔除。88.6%的患者出现渗血，被视为轻度出血且无需干预。11.4%的病例出现中度出血。患者的INR范围为2.00至3.50，77.2%的患者在拔牙当天的INR在2.0至2.5之间。所有拔牙后均未出现需要住院治疗的严重出血情况。出现中度出血的患者返回诊所，接受局部治疗措施以控制出血。仅4例患者出现中度出血，其中3例INR在3.1至3.5之间，1例INR小于3。
在本研究中，我们表明，只要拔牙当天INR等于或小于3.5，服用华法林的患者进行简单拔牙可以安全进行，出血风险不高。拔牙后必须对华法林治疗患者进行密切随访和监测。
