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. 2010 Dec;110(6):691-7.
doi: 10.1016/j.tripleo.2010.03.018. Epub 2010 Jul 2.

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

Ben Balevi  1
Affiliations

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

Ben Balevi. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Dec.

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Objective: The aim of this study was to determine if warfarin should be withdrawn before a single tooth extraction on a patient with a prosthetic heart valve.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