title: MANAGEMENT OF DENTAL EXTRACTIONS IN PATIENTS TAKING WARFARIN AS ANTICOAGULANT TREATMENT: A SYSTEMATIC REVIEW.
abstract: OBJECTIVE
  The management of patients on anticoagulation therapy is challenging. The objective of this study was to conduct a systematic review to establish the effectiveness of hemostatic interventions to prevent postoperative bleeding following dental extractions among patients taking warfarin.
  
  
  METHODS
  A systematic review of the literature was conducted using PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases and applying relevant MeSH terms. Identified studies were screened independently by 2 reviewers using the following selection criteria: tooth extraction, patients taking warfarin as the only anticoagulant, randomized controlled trials and a hemostatic intervention.
  
  
  RESULTS
  Six articles were included in the final review, all evaluating different interventions. Oral or local hemostatic agents were compared in 4 studies where patients continued taking warfarin before and after the procedure; in 3 studies, there were no differences between the agents in preventing postoperative bleeding and, in 1, Histoacryl glue was superior to a gelatin sponge. Two studies compared warfarin continuation with temporary discontinuation and found that continuation did not increase the risk of bleeding in patients who had an international normalized ratio (INR) within the therapeutic range.
  
  
  CONCLUSIONS
  Patients with an INR within the therapeutic range can safely continue taking the regular dose of warfarin before dental extractions. There is no evidence to support or reject the superiority of local hemostatic agents over warfarin discontinuation.
authors.forename: Naamah Jacobs
authors.initials: NJ
authors.lastname: Weltman
authors.forename: Yasmeen
authors.initials: Y
authors.lastname: Al-Attar
authors.forename: Johnson
authors.initials: J
authors.lastname: Cheung
authors.forename: David Philip Bruce
authors.initials: DP
authors.lastname: Duncan
authors.forename: Ashley
authors.initials: A
authors.lastname: Katchky
authors.forename: Amir
authors.initials: A
authors.lastname: Azarpazhooh
authors.affiliation: University of Toronto, Toronto, ON.
authors.forename: Lusine
authors.initials: L
authors.lastname: Abrahamyan
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D017742:Dental Care for Chronically Ill / Q000379:methods*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D006472:Oral Hemorrhage / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014081:Tooth Extraction; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin