Risk factors for bleeding after oral surgery in patients who continued using oral anticoagulant therapy

J Am Dent Assoc. 2015 Jun;146(6):375-81. doi: 10.1016/j.adaj.2015.01.017.


Background: The authors assessed the incidence of postoperative bleeding in patients who were highly anticoagulated and in patients who underwent extensive oral surgical procedures and who continued using oral anticoagulant therapy.

Methods: The authors placed 125 patients receiving anticoagulant therapy into 1 of 3 groups. Group A had 54 patients who were highly anticoagulated (international normalized ratio [INR] ≥ 3.5) in whom up to 3 teeth were extracted. Group B had 60 patients with INR 2.0 to less than 3.5 in whom higher-risk dentoalveolar surgery (extraction of more than 3 teeth or other oral surgery procedure involving raising a mucoperiosteal flap, osteotomy, or biopsy) was performed. Group C had 11 patients whose INR values were 3.5 or higher and who required higher-risk dentoalveolar surgery. Eighty-five healthy participants who underwent surgical procedures similar to those performed in group A and group B were the control group.

Results: Two patients in group A (3.7%), 3 in group B (5.0%), and 2 in group C (18.2%) experienced postoperative bleeding. In the control group, a single bleeding event (1.2%) occurred. All cases of hemorrhage were mild and easily controlled using local hemostatic measures.

Conclusions: Dental extractions in patients who are highly anticoagulated (INR, 3.5-4.2), as well as more extensive oral surgical procedures in patients who are therapeutically anticoagulated, can be performed safely without interruption or modification of the therapy.

Practical implications: Tooth extractions and even more extensive surgical procedures can be performed safely in patients who continue using anticoagulant therapy if proper local hemostatic measures are used and if no other coagulopathies are present.

Keywords: Anticoagulants; anticoagulant therapy; hemorrhage; hemostasis; oral surgical procedures; tooth extraction.

MeSH terms

  • Aged
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Female
  • Hemostatic Techniques
  • Humans
  • Incidence
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Oral Surgical Procedures / adverse effects*
  • Postoperative Hemorrhage / chemically induced
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / etiology*
  • Postoperative Hemorrhage / therapy
  • Retrospective Studies
  • Risk Factors
  • Tooth Extraction / adverse effects


  • Anticoagulants