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Dental Procedures and Oral Surgery

Thromboembolic Risks

Studies show that holding single antithrombotic agents perioperatively increases the risk of acute thrombotic events and does not significantly decrease the risk of bleeding complications in minor dental procedures.

Bleeding Risks

Minor dental procedures are associated with little blood loss.

Major bleeding is rare with continuation of therapeutic anticoagulation. Bleeding risks increase when aspirin and NSAIDs are given in addition to VKAs.

Patients should be given instructions to deal with potential bleeding, and should be advised about when to seek medical attention for excessive bleeding.

General Recommendations for Pre-Procedure Warfarin Management

  • Routine dental cleaning: No warfarin hold necessary
  • Deep cleaning/scaling: Can hold warfarin 0-3 days
  • Root canal: No warfarin hold necessary
  • Fillings/caps/crowns: No warfarin hold necessary
  • Dental extractions/ oral surgery:
    • Single uncomplicated extraction: Can hold warfarin 0-3 days
    • Multiple molar extractions or oral surgery: Hold warfarin 3-5 days

Hemostatic Mouthwash

  • A compounded hemostatic mouthwash (tranexamic acid or aminocaproic acid) can be used if the patient is unable to hold warfarin.
  • Please contact the UCSD Discharge Pharmacy x33279 or UCSD Perlman Pharmacy x78610 to order and for pricing information (is not always covered by insurance).
  • Written prescription should be for tranexamic acid 5% solution, 100mL.  Instructions:  Following dental procedure, hold 10mL (2 tsp) in the mouth for 1-2 minutes, then spit.  May repeat every 2 hours.
  • Solution is good for 5 days after compounding.  Must be refigerated. 
  • Patients:  please contact your provider or dentist to prescribe.




References:

Continuing warfarin therapy does not increase risk of bleeding for patients undergoing minor dental procedures. Brewer AK. Evid Based Dent. 2009;10(2):52.

Dental surgery for patients on anticoagulant therapy with warfarin: a systematic review and meta-analysis. J Can Dent Assoc. 2009 Feb;75(1):41.