Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

Oral Anticoagulation and Dentalalveolar Surgery:

Stop or not?

Hey, Jerry. How are you? Can you help me out this morning. A patient I haven't seen for years just walked into my office. He's in pain. The tooth is fractured and needs to be extracted. Can I send him right over? By the way, he's taking Coumadin.

For patients who are taking Coumadin derivatives such as warfarin and who need to undergo tooth extraction, the general dentist, periodontist or oral and maxillofacial surgeon must determine if it is best to alter or discontinue the warfarin therapy treatment, which risks thromboembolism, or continue therapy and risk uncontrolled bleeding .For procedures such as dental alveolar surgery that rarely cause significant or life threatening bleeding, warfarin can be discontinued. If the patient is at low risk for thromboembolism, the choice is usually to suspend therapy for a few days before surgery. Patients at high isk may be treated by suspending warfain and using bridge anticoagulation therapy with either low molecular weight heparin (LMWH) or unfractionated heparin (UHF).. Research has shown hat as long as surgery is done when the INR is with-in the therapeutic range of 2.0-4.0, the chance of serious bleeding is low when oral anticoagulation therapy is continued.

Risk of Thromboembolism

Low Risk Moderate Risk High Risk

Atrial fibrilation without stroke Venous thrombosis<6 months Mechanical mitral

Cardiomyopathy without Chronic atrial fibrillation with valve

Atrial fibrillation >2 stroke risk factors Venous thrombosis< 3 months

Venous thrombosis>6 monthsMost minor oral surgical procedures can be easily and safely performed while the patients continue their low dose aspirin therapy. The very low risk of post-surgical bleeding is of a significantly lesser concern than the more significant problems of patients developing a thrombolembolis or a myocardial infarction.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍