Jason Erasmus - Oral and Maxillofacial Surgeon, Christchurch, New Zealand

Warfarin and Surgery

Pre-operative Information

Warfarin is an anticoagulant medicine (blood thinner) which works by reducing the clotting ability of the blood. The effectiveness of Warfarin and therefore, the ability of the blood to clot, is measured by a blood test known as an INR. Normally, an up-to-date INR is required before surgery to assess whether the Warfarin dose needs to be adjusted.

General Instructions

  • Take your Warfarin as directed by your doctor.
  • Please arrange an INR the day before your surgery.
  • Eat only soft or pureed food for the first week or more following the procedure, and if possible, favour the other side of your mouth.
  • You may use Paracetamol, Panadeine or Digesic for pain relief as directed. Do not use Aspirin or any other NSAID's (non-steroidal anti-inflammatory drugs) such as Nurofen or Voltaren, as these may cause serious bleeding.
  • Apart from using Tranexamic acid mouth rinse, do not rinse the mouth out for 12 hours after your surgery.

Tranexamic Acid Mouth Rinse

Tranexamic acid inhibits the breakdown of blood clots and can reduce the risk of post-operative bleeding. For oral surgery, it is effective as a mouth rinse. One Tranexamic acid tablet should be dissolved in 10mls of water (1 tablespoon). This will take 5-10 minutes.
Gently rinse this solution around the mouth and over the surgical site(s) for 2 minutes, and then spit out.
On the day of surgery do your first Tranexamic acid mouth rinse in the evening at 6pm, and then again as late as possible (immediately before going to bed).
The following day and over the next 7 days, use the mouth rinse 4 times a day:

  • First thing in the morning when you get up
  • 12:00pm (midday)
  • 6:00pm (evening)
  • As late as possible (immediately before going to bed)
  • Do not eat or drink for half an hour after using the mouth rinse.

If Bleeding Occurs:

  • Make a pressure pad from a clean damp handkerchief or the sterile gauze.
  • Identify the site(s) of the bleeding and place the damp pressure pad directly over it.
  • Bite firmly on the pressure pad for 20 minutes by the clock.
  • If the bleeding has not stopped, then keep biting on a pressure pad and contact Jason Erasmus.

Remember to come along to your Post-Op Check Appointment. You will have been told the date. 
If you have any problems before then, please contact us:

Office: 03 3551155 or Jason Erasmus: 021 873 783