• For use at Wexham Park and Heatherwood Hospitals only

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Guidance has been issued (2009) related to the removal of teeth in dental practice for patients who are on warfarin. Patients should be managed according to these guidelines and not referred to hospital for “routine” extractions. The guidelines stipulate that extractions can safely be carried out in primary care in the following circumstances:

• Where the INR is less than 4.0.

• If the socket is packed and sutured.

Warfarin should not be stopped but the INR must be checked within 24 hours of the planned extraction (patients can usually co-ordinate this themselves with either their doctor or anti- coagulant clinic).

Patients should be referred if other coagulopathies co-exist, if there is a need for intravenous antibiotic cover or if the INR is maintained at over 4 (the latter will be recorded in the patient’s anticoagulant book).

Extractions should be timed appropriately and ideally should take place at the beginning of the week (such that delayed re-bleeding problems can be managed during the working week) and in the morning (such that immediate re-bleeding problems can be managed during the working day).

These guidelines are available at https://www.app.dundee.ac.uk/tuith/Static/info/warfarin.pdf and are summarised below.

North West Medicines Information Centre (2009) Surgical Management of the Primary Care Dental Patient on Warfarin. Available at: www.app.dundee.ac.uk/tuith/Static/info/warfarin.pdf [Accessed 12/08/21]

Jacobs Weltman N et al Management of Dental Extractions in Patients taking warfarin as anticoagulant treatment: a systematic review. J Can Dent Assoc 2015 81 p.f20 Available at: https://pubmed.ncbi.nlm.nih.gov/26679334/ [Accessed 12/08/21]

Scottish Dental Clinical Effectiveness Programme (2013) Management of acute dental problems: guidance for healthcare professionals. Available at: https://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP+MADP+Guidance+March+2013.pdf [Accessed 12/08/21]

If the patient requires concurrent endocarditis prophylaxis follow guidelines making note of potential drug interactions.

If the patient requires post-operative analgesia non-steroidal anti-inflammatory drugs should be avoided because of interactions.

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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