Should warfarin be discontinued before a dental extraction? A decision-tree analysis.
OBJECTIVE
The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve.


METHODS
A quantitative decision tree was constructed to assess the expected utility values of 2 typical strategies to manage the dental extraction on a patient currently medicated with warfarin. Probabilities and utilities for a cardiovascular accident and major bleeding from a dental extraction were taken from the literature.


RESULTS
The decision slightly favors withholding warfarin: generating an optimal expected utility value of 0.976 utile. This was only 0.02 utile higher than the alternative option of continuing warfarin for a dental extraction.


CONCLUSIONS
The decision to withhold or continue warfarin before a dental extraction depends more on the relative risk of a major bleeding between the 2 medical management strategies than on the consequences of a cardiovascular accident.
Balevi
Ben
B
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. drben@dentalben.com
D000925:Anticoagulants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology; D002423:Cause of Death; D003663:Decision Trees; D006350:Heart Valve Prosthesis; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011336:Probability; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology; D014081:Tooth Extraction; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D006490:Hemostatics; D014859:Warfarin