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Should warfarin be discontinued before a dental extraction? A decision-tree analysis

Journal
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology
Publisher
Elsevier - Mosby
Volume
110
Issue
6
Identifiers
DOI: 10.1016/j.tripleo.2010.03.018
Disciplines
  • Design
  • Medicine
License
Unknown

Abstract

Objective The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve.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.

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