Study provides clarity on blood-thinning medication during tooth extraction
Patients can continue taking blood-thinning medication without interruption during tooth extraction. This applies regardless of whether they are taking the drug warfarin or its alternative, according to a new study from Malmö University.
Tooth extraction is the most common surgical procedure performed by dentists. However, these procedures present difficult trade-offs for dental staff when it comes to those who take blood-thinning medication.
Pausing the medication reduces the risk of bleeding but can simultaneously increase the risk of blood clots and life-threatening conditions.
In the case of the drug warfarin, which has been on the market for a long time, teeth are usually extracted without interrupting treatment. However, there has been greater uncertainty regarding the new DOACs (direct-acting oral anticoagulants), which are now being taken by an increasing number of patients, particularly those over 65.
The reason for this uncertainty was that general surgeons reported serious bleeding incidents in patients taking DOACs when the new drugs were introduced. Furthermore, dentists were concerned that the anticoagulant effect of these new drugs could not be monitored using International Normalised Ratio which are used to measure how fast blood clots.
“We therefore wanted to establish a better evidence base, as there have been no clear guidelines on whether DOAC treatment should be paused during tooth extraction,” says Krister Johansson, who recently completed his PhD at Malmö University's Faculty of Odontology.
In his thesis, Johansson examined the risk of bleeding during tooth extraction in individuals taking DOACs by reviewing previous studies and extracting teeth from patients taking Warfarin or DOACs.
“The most important finding of the thesis is that patients can continue taking DOACs without interruption when having teeth removed, regardless of whether the extraction is uncomplicated or surgical. This is because the risk of bleeding appears to be lower for them than for those taking warfarin.”
Johansson explains that any bleeding experienced by people taking DOACs is usually minor and can be managed at home with clear instructions. However, it is important that dentists suture the wound and use haemostatic agents during treatment.
“The process is also made easier for dentists if DOAC patients can continue taking their medication during tooth extraction. This is because they no longer need to consult the doctor in charge about interrupting their medication,” he says.
