Risk Of Post-operative Bleeding After Dental Procedures in Warfarinized Patients

Objectives: The purpose of this retrospective study was to investigate the frequency of bleeding complications after dental procedures in patients on warfarin and the possible contributing risk factors. Methods: The CoaguChek System (Roche Diagnostics, Indianapolis) was used to obtain an in-office INR value for patients thought to be at risk for developing post-operative complications. Information collected included demographics, medical history, concomitant medication reported to interfere with coagulation (specifically aspirin, clopidogrel and non-steroidal anti-inflammatory medications), type of dental procedure performed, the use of local hemostatic agents at time of dental procedure, pre- and post-operative blood products utilized and post-operative bleeding. Results: We identified 123 patients, who had a total of 242 dental appointments. The mean age was 54 ± 15.7 years (range: 21 - 92), with 62 males (50 %). Thirty-five patients (28%) were on concomitant medications that could potentiate bleeding. The average INR value for all appointments (n=242) was 2.4 ± 1.2 (range: 0.8 – above 8). Two hundred and forty eight extractions were performed in 105 appointments. There were 6 episodes (2.5%) of persistent bleeding post dental treatment. The average INR value for these 6 patients was 2.5 ± 1.3 (range: 1.1 – 4.7). Conclusions: The results of this study suggest that the incidence of persistent bleeding (2.5%) after invasive dental procedures is low in patients on warfarin therapy. The study's results also suggests that patients' with a significant medical history or those using concomitant medications may affect their ability to clot and increase their risk of bleeding.