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Blood Thinners No Barrier To Tooth Extraction
September 6, 2011

By Nancy Volkers
InteliHealth News Service

INTELIHEALTH - Dental surgery is safe in most people who take blood thinners, says a review of published research.

Scientists from Madrid Hospital, Spain, and the University of Granada did the study. They reviewed and pooled information from 12 published studies. In all, the studies included 1,194 people who had tooth extractions. Everyone in the study was taking warfarin (Coumadin) to reduce the risk of blood clots. This drug is commonly prescribed for people with atrial fibrillation or an artificial heart valve.

After the extractions, 83 people - about 7% - had extensive bleeding. In 77 of the cases the bleeding was stopped right away. In some people the bleeding lasted up to 10 days.

Of the people who had bleeding, only six needed to have their medicine adjusted. For the others, bleeding was controlled using direct pressure, and sometimes also with glues or other drugs that encourage clotting. In two cases, the surgical wound was opened and restitched.

Bleeding was more common in people who had teeth removed because of gum disease or an infection around a wisdom tooth. It was less common among people who had teeth removed because of decay.

Some dentists have people stop taking blood thinners a few days before surgery. The authors of this review say that this may not be necessary for most people.

Doctors measure the blood's clotting ability using a number called the International Normalized Ratio (INR). People on blood thinners generally have an INR between 2.0 and 3.5. Higher numbers mean that the blood is less likely to clot. However, this also means that uncontrolled bleeding is more of a risk.

In this study, the average INR was about 2.7. But some people did have values above 3.5. The authors say that extractions are safe for people with an INR up to 4.0. People should maintain good oral hygiene the week before the surgery.

The study appears in the September 1 issue of the journal Oral Medicine, Oral Pathology and Oral Surgery.

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