Comparison of the effects of warfarin and heparin on bleeding caused by dental extraction (a clinical study)

Postponement of the dental treatment of cardiovascular patients generallyresults in dental problems requiring tooth extraction. Focal infection caused bydental decay could be life-threatening for the patients with cardiac valvular diseaseor valvular prosthesis. Replacement of warfarin with heparin composes a safe andwell controlled protocol for dental extractions in such patients, as it minimizes therisk of bleeding and allows for maintaining the therapeutic anticoagulation.However, since this protocol requires hospitalization, its application for minor oralsurgical procedures such as dental extraction is time consuming, interferes withlabor and leads to elevated treatment expenses.The aim of this study is to evaluate the safety of dental extraction withoutaltering the warfarin regimen in patients with an INR value ranging 1- 4.Patients who were to undergo tooth extraction divided into four groups asfollows;*Patients receiving warfarin (Group 1)*Patients receiving Low Molecular Weighed Heparin (LMWH) instead of warfarin(Group 2)*Patients receiving unfractioned heparin (UFH) instead of warfarin (Group 3)*Control group consisting of healthy individuals receiving no medication (Group4)Total amount of bleeding (mg) was measured for 20 minutes after tooth extraction.The INR values on the operative day were recorded in the first three groups. Theresults were statistically analyzed by analysis of variance (ANOVA), Fisher?s LSDpost hoc, Pearsons? correlation, Chi-square and Student?s t-test.The results of this study suggest that, with the aid of local hemostatic agentsdental extraction of patients receiving warfarin, who have an INR value rangingfrom 1 to 4, could be carried out without a significant risk of bleeding.Key words: Bleeding, Dental extraction, Heparin, Warfarin.