Anticoagulants & Antiplatelets

Dental Considerations for Patients Taking Acenocoumarol (VKA)

Check INR within 24 hours (ideally 72h) before treatment

An invasive procedure is planned. A recent INR is required before proceeding.

Emergency vs routine management

If EMERGENCY — what to do

• Check INR on the day (point-of-care) or within the previous 24 h.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• INR < 4: proceed with the emergency treatment without stopping the anticoagulant.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• INR ≥ 4: do not extract — control pain/infection non-surgically (drainage, pulp extirpation, analgesia) and refer to the anticoagulant clinic/hospital.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Avoid NSAIDs, metronidazole, macrolides and azoles (raise INR / bleeding); paracetamol for pain.Ref: SDCEP. Drug Prescribing for Dentistry, 3rd ed. (2016, updated 2021)

If ROUTINE — what to do

• Never stop warfarin/acenocoumarol for dental treatment.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Check INR within 24 h before treatment (up to 72 h if stably anticoagulated).Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
• Book early in the day and early in the week; limit extractions to ~3 teeth per visit, staged if more.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022

Clinical precautions

• Obtain INR ≤24h before (stable patients ≤72h)
• Do NOT interrupt warfarin

Information & tests to request

• Most recent INR

At a glance by procedure

Initial assessment before lab results or timing details are entered.

Procedure	Initial assessment
Examination / radiographs	ROUTINE No bleeding risk for this procedure
Supragingival scaling / polish	MODIFY / CAUTION Check INR within 24 hours (ideally 72h) before treatment
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Check INR within 24 hours (ideally 72h) before treatment
Root canal treatment	ROUTINE No bleeding risk for this procedure
Simple extraction (1–3 teeth)	MODIFY / CAUTION Check INR within 24 hours (ideally 72h) before treatment
Surgical / bony extraction	MODIFY / CAUTION Check INR within 24 hours (ideally 72h) before treatment
Implant placement	MODIFY / CAUTION Check INR within 24 hours (ideally 72h) before treatment

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

SDCEP 2022 — Management of Dental Patients Taking Anticoagulants
SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
SDCEP. Drug Prescribing for Dentistry, 3rd ed. (2016, updated 2021)

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.