The management of dental extractions for patients taking warfarin?
Warfarin is a vitamin K antagonist that impairs the
liver synthesis of coagulation factors II, VII, IX and X, and endogenous proteins C and S affecting both the
intrinsic and extrinsic coagulation pathways, resulting
in impaired fibrin formation.In the past, the management of patients
therapeutically anticoagulated with warfarin requiring dental extractions has posed a dilemma to the attending
dental surgeon. The following factors have probably contributed to the favourable evolution of the management of these patients: increased training and
experience of dentists; improved dental status of
patients, minimizing necessity for multiple extractions
and increasing awareness of local fibrinolysis in the
oral cavity and the use of local measures. These
principles have been taught by the authors over the last decade. They have been tested in formal clinical
trials and used on over a thousand patients
anticoagulated with warfarin. The result is that all
patients can now undergo dental extractions on an
ambulatory basis without interruption of their normal warfarin regimen. The cost differential is impressive
and obviously represents considerable savings both for
the patient and society. However, more importantly the
elimination of the need for hospitalization and for
multiple venipunctures and infusions provides great
comfort and psychological benefit for the patient.
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