Treatment with local hemostatic agents and primary closure after tooth extraction in warfarin treated patients.

The aim of this retrospective study was to assess the frequency of postoperative bleeding in patients on warfarin after tooth removal followed by a complete soft tissue closure of the surgical site. A total of 124 consecutive patients, 69 males and 55 females with a mean age of 71 years (range 28-95 years) were included in this study. Inclusion criteria were patients on warfarin with an INR <or=3.5 who were referred for tooth removal (single or multiple) during 2004-2009. After tooth extraction all sockets were packed with an absorbable haemostatic gelatin sponge or a collagen fleece and subsequently the sockets was primary closed with sutures. 5/124 (4%) patients returned with postoperative bleedings. All patients with a postoperative bleeding had received a surgical extraction in the posterior part of the maxilla. Consequently no patient had a postoperative bleeding in the mandible. None of the 124 patients returned to the clinic with a dry socket or postoperative pain. 3/124 (2%) patients returned with postoperative infection that required antibiotic treatment. All patients who bled were managed conservatively and none was admitted to hospital. According to the protocol of this study (local hemostatic, primary closure, sutures and tranexamic acid) the risk of postoperative bleeding after tooth removal in patients on continued warfarin medication is low.