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Objective The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve. Study design A quantitative decision tree was constructed to assess the expected utility values of 2 typical strategies to manage the dental e...

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Published in:Oral surgery, oral medicine, oral pathology, oral radiology and endodontics oral medicine, oral pathology, oral radiology and endodontics, 2010-12, Vol.110 (6), p.691-697
Main Author: Balevi, Ben, BEng, DDS, DipEBHC (Oxford), MSc
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Cardiovascular Diseases - etiology
Cause of Death
Decision Trees
Dentistry
Heart Valve Prosthesis
Hemostasis, Surgical
Hemostatics - therapeutic use
Humans
Medical sciences
Middle Aged
Otorhinolaryngology. Stomatology
Pharmacology. Drug treatments
Postoperative Complications
Postoperative Hemorrhage - etiology
Probability
Risk Assessment
Stroke - etiology
Surgery
Tooth Extraction
Treatment Outcome
Warfarin - therapeutic use
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Summary:Objective The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve. Study design 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. Conclusion 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.
ISSN:1079-2104
1528-395X
DOI:10.1016/j.tripleo.2010.03.018