Oral surgery in patients using oral anticoagulant drugs and warfarin





Tooth extraction; Anticoagulant; Bleeding; Surgery; Teaching.


Surgical procedures are in the daily life of the dental surgeon and due to the longer maintenance of natural teeth by patients in relation to age, oral surgeries are becoming increasingly common in patients who use oral anticoagulants, so the dental surgeon must stay aware of the actions to be taken. This study aims to review the literature on the conduct to be taken in oral surgeries in patients who use anticoagulants continuously, evaluating the risk of discontinuing this medication and the risk of bleeding. For the construction of this work, a bibliographic survey was carried out in the databases SciVerse Scopus, Scientific Electronic Library Online (Scielo), U.S. National Library of Medicine (PUBMED) and ScienceDirect, using the Mendeley reference manager. The results of this research reveal that the continuation of drug therapy with warfarin in patients undergoing simple and atraumatic tooth extractions can be performed as long as the patient is in the appropriate therapeutic range analyzed through the INR. Regarding the extraction of invasive third molars, the procedure can be performed when the INR is up to 2.11, and your medical history is evaluated in detail, but more studies are needed for this type of procedure.


Aframian, D. J., Lalla, R. V., & Peterson, D. E. (2007). Management of dental patients taking common hemostasis-altering medications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 103(SUPPL.), S45.e1-S45.e11. https://doi.org/10.1016/j.tripleo.2006.11.011

Andrade, M. V. S., Andrade, L. A. P., Bispo, A. F., Freitas, L. de A., Andrade, M. Q. S., Feitosa, G. S., & Feitosa-Filho, G. S. (2018). Evaluation of the bleeding intensity of patients anticoagulated with warfarin or dabigatran undergoing dental procedures. Arquivos Brasileiros de Cardiologia, 111(3), 394–399. https://doi.org/10.5935/abc.20180137

Bajkin, B. V, Vujkov, S. B., Milekic, B. R., & Vuckovic, B. A. (2015). Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy. The Journal of the American Dental Association, 146(6), 375–381. https://doi.org/https://doi.org/10.1016/j.adaj.2015.01.017

Breik, O., Cheng, A., Sambrook, P., & Goss, A. (2014). Protocol in managing oral surgical patients taking dabigatran. Australian Dental Journal, 59(3), 296–301; quiz 401. https://doi.org/10.1111/adj.12199

Breik, O., & Grubor, D. (2008). The incidence of mandibular third molar impactions in different skeletal face types. Australian Dental Journal, 53(4), 320–324. https://doi.org/10.1111/j.1834-7819.2008.00073.x

Büller, H. R., Agnelli, G., Hull, R. D., Hyers, T. M., Prins, M. H., & Raskob, G. E. (2004). Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126(3 Suppl), 401S-428S. https://doi.org/10.1378/chest.126.3_suppl.401S

Cannon, P. D., & Dharmar, V. T. (2003). Minor oral surgical procedures in patients on oral anticoagulants--a controlled study. Australian Dental Journal, 48(2), 115–118. https://doi.org/10.1111/j.1834-7819.2003.tb00019.x

Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P. A., Themeles, E., Varrone, J., Wang, S., Alings, M., Xavier, D., Zhu, J., Diaz, R., Lewis, B. S., Darius, H., Diener, H.-C., Joyner, C. D., & Wallentin, L. (2009). Dabigatran versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine, 361(12), 1139–1151. https://doi.org/10.1056/NEJMoa0905561

Feliciano, A. G. R. de S. (2018). Abordagem cirurgica odontológica em pacientes que fazem uso de anticoagulantes. 1–10.

Guyatt, G. H., Akl, E. A., Crowther, M., Gutterman, D. D., & Schuünemann, H. J. (2012). Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2, Supplement), 7S-47S. https://doi.org/https://doi.org/10.1378/chest.1412S3

Keeling, D. M., Baglin, T., Tait, C., Watson, H., Perry, D., Baglin, C., Kitchen, S., & Makris, M. (2011). Guidelines on oral anticoagulation with warfarin - fourth edition. British Journal of Haematology, 154(3), 311–324. https://doi.org/10.1111/j.1365-2141.2011.08753.x

Lamminen, H., Niiranen, S., Niemi, K., Mattila, H., & Kalli, S. (2002). Personal health care and the new media in anticoagulant treatment. Scandinavian Journal of Primary Health Care, 20(2), 123–125.

Lu, S.-Y., Lin, L.-H., & Hsue, S.-S. (2018). Management of dental extractions in patients on warfarin and antiplatelet therapy. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 117(11), 979–986. https://doi.org/10.1016/j.jfma.2018.08.019

Müller, M., Schlittler, F., Schaller, B., Nagler, M., Exadaktylos, A. K., & Sauter, T. C. (2019). Characteristics, treatment and outcome of bleeding after tooth extraction in patients on DOAC and phenprocoumon compared to non-anticoagulated patients—a retrospective study of emergency department consultations. Clinical Oral Investigations, 23(5), 2273–2278. https://doi.org/10.1007/s00784-018-2676-7

Pereira, A., Shitsuka, D., Parreira, F., & Shitsuka, R. (2018). Método Qualitativo, Quantitativo ou Quali-Quanti. In Metodologia da Pesquisa Científica. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1. Acesso em: 28 março 2020.

Petursson, H., Getz, L., Sigurdsson, J. A., & Hetlevik, I. (2009). Current European guidelines for management of arterial hypertension: are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population. BMC Family Practice, 10, 70. https://doi.org/10.1186/1471-2296-10-70

Rosencher, N., Arnaout, L., Chabbouh, T., & Bellamy, L. (2008). [Rivaroxaban (Xarelto): efficacy and safety]. Annales francaises d’anesthesie et de reanimation, 27 Suppl 3, S22-7. https://doi.org/10.1016/S0750-7658(08)75143-8

Shamoun, F. E., Martin, E. N., & Money, S. R. (2013). The novel anticoagulants: The surgeons’ prospective. Surgery (United States), 153(3), 303–307. https://doi.org/10.1016/j.surg.2012.09.016

Teles, J. S., Fukuda, E. Y., & Feder, D. (2012). Varfarina : perfil farmacológico e interações medicamentosas com antidepressivos Warfarin : pharmacological profile and drug interactions with antidepressants. Einstein, 10(1), 110–115.

Virjo, I., Mäkelä, K., Aho, J., Kalliola, P., Kurunmäki, H., Uusitalo, L., Valli, M., & Ylinen, S. (2010). Who receives anticoagulant treatment with warfarin and why? A population-based study in Finland. Scandinavian Journal of Primary Health Care, 28(4), 237–241. https://doi.org/10.3109/02813432.2010.514138

Wallvik, J., Själander, A., Johansson, L., Bjuhr, O., & Jansson, J.-H. (2007). Bleeding complications during warfarin treatment in primary healthcare centres compared with anticoagulation clinics. Scandinavian Journal of Primary Health Care, 25(2), 123–128. https://doi.org/10.1080/02813430601183108

Weitz, J. I., Hirsh, J., & Samama, M. M. (2008). New antithrombotic drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133(6 Suppl), 234S-256S. https://doi.org/10.1378/chest.08-0673



How to Cite

SILVA, R. B. .; PEREIRA, L. D. .; RODRIGUES , M. C. .; CARNEIRO , G. K. M. .; ALBUQUERQUE, I. F. de S. A.; SANTOS, M. de L. .; RAPOSO, D. V. A. .; GOMES, A. C. C. .; ALVES, M. V. .; LINS, R. M. . Oral surgery in patients using oral anticoagulant drugs and warfarin. Research, Society and Development, [S. l.], v. 11, n. 6, p. e31811629061, 2022. DOI: 10.33448/rsd-v11i6.29061. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/29061. Acesso em: 22 may. 2022.



Health Sciences