Teeth extraction and warfarin – receipes for caution

Feb 2015 – Coroner reports a dentist to the Dental Board of Australia following an inquest into the death of a female patient.

The death of anyone is the worst nightmare for any health care practitioner. And to be implicated in the cause of death is quite tragic.
This case was one where the female patient was on warfarin and died of blood loss two days after teeth had been extracted.

The dentist was criticised by the coroner for a number of things:

  1. No written note of the INR
  2. Not following the therapeutic guidelines on managing a patient who is on warfarin with minor oral surgery.

One of the thought provoking inferences was that the dentist should have been using tranexamic acid mouthwashes with this patient.

Tranexamic acid mouthwashes Рthese are not available but you can mix an equivalent with dissolvable tablets. The patient will need to buy 100 tablets and use 9 of these over the course of 2 days. If the dentist purchases and sensibly redistributes these the labeling and control of these tablets could turn out to be a nightmare. Also just writting the original script needs lots of consideration as these tablets are NOT to be taken orally for people who have had blood clots in many parts of their body.(Many patients on warfarin fit into this category)

Decisions, decisions.
I can’t imagine the families distress at losing their mother with a preventable incident.

I would like to fully incorporate all the learning from this tragedy into improving safety and quality in my practice. The big question is how to best manage the use of tranexamic acid, without causing another problem to someone else!