What is the recommended management for a patient on warfarin undergoing a non-surgical dental procedure?

• A. Discontinue warfarin one week prior to procedure.
• B. Stop warfarin and use only mechanical hemostasis during procedure.
• C. Do not discontinue warfarin; coordinate with physician; check INR if indicated; use local hemostasis and minimal invasive technique.
• D. Increase warfarin dose to reduce bleeding risk

Answer: (C)

The key idea is balancing bleeding risk with the risk of a clot by continuing anticoagulation for minor dental work and using careful planning. Warfarin affects the body's ability to form clots, so patients on it can bleed more during procedures. For many non-surgical dental procedures, the safest approach is not to stop the medication abruptly. Instead, coordinate with the patient’s physician, ensure the INR is within the therapeutic range if indicated, and proceed with heightened local hemostasis using minimally invasive technique. Local measures such as precise tissue handling, suturing when needed, and the use of hemostatic agents or mouthwash can help control bleeding. Increasing the dose or stopping warfarin without medical guidance increases either bleeding risk or thromboembolic risk, which is not appropriate for a routine dental procedure. If the INR is markedly elevated or the procedure carries higher bleeding risk, medical consultation to adjust therapy or delay the procedure is warranted.