Dental Surgery for Patients on Anticoagulant Therapy with Warfarin: A Systematic Review and Meta-analysis

Purpose: To evaluate the effect of continuing warfarin therapy on the bleeding risk of patients undergoing elective dental surgical procedures.

Methods: Data sources were the MEDLINE and EMBASE databases, the Cochrane Central Register of Controlled Trials, a manual citation review of the relevant literature, content experts and relevant abstracts from the proceedings of the International Association for Dental Research. Study selection was carried out independently by 2 reviewers, as was quality assessment. Data extraction was done by 3 reviewers. Differences were resolved by consensus. Eligible studies were randomized controlled trials that compared the effects of continuing the regular dose of warfarin therapy with the effects of discontinuing or modifying the dose on the incidence of bleeding in patients undergoing dental procedures.

Results: Five trials (a total of 553 patients) met the inclusion criteria. Compared with interrupting warfarin therapy (either partial or complete), perioperative continuation of warfarin with patients' usual dose was not associated with an increased risk for clinically significant nonmajor bleeding (relative risk [RR], 0.71; 95% confidence interval [CI]: 0.39–1.28; p = 0.65; I2 = 0%) or an increased risk for minor bleeding (RR, 1.19; 95% CI: 0.90–1.58; p = 0.22; I2 = 0%).

Conclusions: Continuing the regular dose of warfarin therapy does not seem to confer an increased risk of bleeding compared with discontinuing or modifying the warfarin dose for patients undergoing minor dental procedures.