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Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on warfarin therapy: a multicenter retrospective study in Japan

  • Shin-ichi YamadaEmail author
  • Takumi Hasegawa
  • Sakiko Soutome
  • Hitoshi Yoshimura
  • Masaaki Miyakoshi
  • Nobuhiro Ueda
  • Kenjiro Okamoto
  • Sumiyo Hishida
  • Satoshi Rokutanda
  • Hirokazu Nakahara
  • Shigeyuki Fujita
  • Masaya Akashi
  • Yoshimasa Kitagawa
  • Tadaaki Kirita
  • Yasuyuki Shibuya
  • Masahiro Umeda
  • Hiroshi Kurita
Original Article


Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P < 0.001). The cutoff value for PT-INR was 2.11 based on a receiver-operating characteristic analysis. A multivariate analysis indicated that an elevated PT-INR value [hazard ratio (HR) 3.798, 95% confidence interval (CI) 1.400–10.467, P < 0.01], preoperative antibiotic administration (HR 4.434, 95% CI 1.591–14.775, P < 0.01), difficulties with intraoperative hemostasis (HR 16.298, 95% CI 2.986–110.677, P < 0.01), and higher serum creatinine levels (HR 7.465, 95% CI 1.616–39.576, P < 0.05) are significant predictors of postoperative hemorrhage after lower third molar extraction. Multivariate correlations were observed between risk factors including an elevated PT-INR value, preoperative antibiotic administration, and higher serum creatinine levels, and postoperative hemorrhage after lower third molar extraction in patients receiving warfarin therapy. Clinicians need to consider these risk factors for postoperative hemorrhage after the lower third molar extraction and monitor PT-INR in patients receiving warfarin therapy.


Postoperative hemorrhage Lower third molar Extraction Warfarin therapy Risk factor 


Author contributions

SY and HK: conception and design of the study. SY and HK: analysis and interpretation of data. SY, TH, SS, HY, MM, NU, KO, SH, SR, HN, SF, MA, YK, TK, YS, MU: collection and assembly of data. SY: drafting of the article. SY: critical revision of the article for important intellectual content. HK: final approval of the article.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of the Shinshu University School of Medicine. (No3798).

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© The Society of The Nippon Dental University 2019

Authors and Affiliations

  • Shin-ichi Yamada
    • 1
    Email author
  • Takumi Hasegawa
    • 2
  • Sakiko Soutome
    • 3
  • Hitoshi Yoshimura
    • 4
  • Masaaki Miyakoshi
    • 5
  • Nobuhiro Ueda
    • 6
  • Kenjiro Okamoto
    • 7
  • Sumiyo Hishida
    • 8
  • Satoshi Rokutanda
    • 3
  • Hirokazu Nakahara
    • 9
  • Shigeyuki Fujita
    • 7
  • Masaya Akashi
    • 2
  • Yoshimasa Kitagawa
    • 5
  • Tadaaki Kirita
    • 6
  • Yasuyuki Shibuya
    • 8
  • Masahiro Umeda
    • 3
  • Hiroshi Kurita
    • 1
  1. 1.Department of Dentistry and Oral SurgeryShinshu University School of MedicineMatsumotoJapan
  2. 2.Department of Oral and Maxillofacial SurgeryKobe University Graduate School of MedicineKobeJapan
  3. 3.Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental SciencesNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
  5. 5.Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental MedicineHokkaido UniversitySapporoJapan
  6. 6.Department of Oral and Maxillofacial SurgeryNara Medical UniversityKashiharaJapan
  7. 7.Department of Oral and Maxillofacial SurgeryWakayama Medical UniversityWakayamaJapan
  8. 8.Department of Oral and Maxillofacial SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
  9. 9.Department of Dentistry and Oral SurgeryOsaka City University Graduate School of MedicineOsaka CityJapan

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