Going to the Dentist While Taking Warfarin

By: Alere Staff

There are many areas of dental care that could affect the heart, including whether a patient is taking anticoagulation medication. Since treating heart patients with dental problems must be done carefully, you should advise your dentist of any heart conditions, cardiac problems, and medication you are taking, like warfarin.

Bleeding Risk

There have not been many studies measuring how much blood is lost during dental procedures. One small study however found no difference in the blood loss between patients who continued warfarin and those who stopped it 72 to 96 hours before the procedure.1

Do I have to stop taking warfarin for dental procedures?

It has been common for patients taking warfarin to stop taking it several days before certain procedures. If you stop taking or take less warfarin before the dental treatment, this could increase your chance of a blood clot.1 During recent years and several studies and clinical reviews, it is now more generally agreed that anticoagulant drug regimens should not be altered or reduced prior to treatment.2-4

Another option instead of stopping or reducing warfarin is to bridge warfarin and heparin. Bridging refers to giving a short-acting anticoagulant, usually heparin given by injection for 10 to 12 days around the time of the procedure. But, even bridging warfarin with heparin has recently been under review and may not be necessary, depending on the individual.5, 6

Talk to your doctors

If you have a dental procedure coming up, make sure your dentist knows you are taking warfarin. Your dentist and your treating doctor can tell you whether you are at risk for bleeding. Talking to both your dentist and doctor managing your warfarin would help determine your best option before the procedure.

  1. Campbell JH, Alvarado F and Murray RA. Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered? J Oral Maxillofac Surg 2000; 131: 131-5.
  2. Todd DW. Anticoagulated patients and oral surgery. Arch Intern Med 2003; 163: 1242.
  3. Linnebur, S. A., et al. Educational Practices Regarding Anticoagulation and Dental Procedures in U.S. Dental Schools. Journal of Dental Education February 1, 2007 vol. 71 no. 2 296-303.
  4. Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med 1998; 158: 1610-6.
  5. Armstrong MJ, et al "Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology" Neurology 2013; 80: 2065-2069.
  6. Kovich O and Otley CC. Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. J Am Acad Dermatol 2003; 48: 233-7.