What is the recommended management approach for a patient on warfarin undergoing a dental extraction?

• A. Discontinue anticoagulation before procedure.
• B. Coordinate with prescriber, keep INR in the therapeutic range, use local hemostasis; do not discontinue anticoagulation without medical advice.
• C. Rely on natural clotting without adjustments.
• D. Use systemic antibiotics to enhance hemostasis.

Answer: (B)

Balancing bleeding risk with thromboembolic risk during a dental extraction in a patient taking warfarin is the key idea. Warfarin reduces vitamin K–dependent clotting factors, so extra bleeding can occur during extraction. The safest approach is to work with the prescribing clinician, keep the patient’s INR within the therapeutic range for the procedure, and emphasize local bleeding control at the site. Do not stop anticoagulation on your own; stopping it without medical guidance can raise the risk of dangerous clotting events. If the INR is out of range or the procedure is more intensive, the prescriber may adjust therapy or arrange bridging, but this is done under medical supervision. Use strong local hemostasis—gentle, atraumatic technique, suturing, packing, and appropriate hemostatic agents or antifibrinolytics as indicated. Relying on natural clotting without addressing the anticoagulation, or using antibiotics to “help” hemostasis, are not appropriate strategies.