adjusting anti-coag. for tooth extraction

[lifelove]

I am to have a tooth pulled, and little did I know that to do so I am to change my anti-coagulation regime complelely. 3 days' worth of self-injections of Lovenox, then nothing on the day of the extraction or the day after, have my INR checked the day of extraction (must be below 1.6 for procedure), then 2 days after extraction back to normal warfarin dose. ! What a pain! Especially because this will be my first time to this dentist, and do not know for sure that they will be able to extract the tooth that day or just do a consultation and have me return for the extraction. So I guess my Q is: if I don't alter my anti-coagulation and am able to have the tooth extracted that day, is it safe to do so? Has anyone had a similar experience/dilemma? Thanks!

 

[JimL]

Hi Lifelove and welcome.
Check out www.warfarinfo.com on this question.

 

[Ross]

http://www.warfarinfo.com/dentalprocedures.htm

M. J. Wahl in the January 2000 edition of the Journal of The American Dental Association published a study of 950 people who had 2,400 dental procedures done. None of these people stopped their warfarin. There were only 12 incidents (about 1% of the time) where anything more than holding a pad with slight pressure was required to stop bleeding. In these 12 incidents, only 3 times was the INR at or below the therapeutic level. The author concludes that stopping warfarin for dental surgery is not based on scientific fact, but is a myth.

Evans et al reported on a randomized trial in which 52 patients stopped warfarin two days before a dental extraction and 57 patients continued warfarin throughout the extraction period. The difference between bleeding rates were statistically insignificant. The authors concluded that continuing warfarin when the INR was less than 4.1 caused no increase in clinically significant bleeding.


I think you need to see another dentist! There is no need to stop your warfarin for a simple tooth extraction. It's good that they want to bridge with heprin, but they have that wrong too. You should start back on your Coumadin the night of extraction, not 2 or 3 days later. Someone is seriously not up to speed here.

 

[RandyL]

Okay Ross, How come you haven't chimed in on my thread? I need advice too.

http://www.valvereplacement.com/forums/showthread.php?t=15789

 

[Granbonny]

I'm confused?Who told you this information? The new dentist office? If so, I would make a call back to them and ask if he/she will extract the tooth your first visit?..Whichever way, you do know that you have to pre-med with 4 500mg of Amox. 1 hour before your visit. Just probing around in your mouth you have to do this...The dentist should script it for you...(Amox) I just finished up a new bridge..I only lowers my coumadin by a tad 2 days before my visit..each time..I think I went a total of 5 visits before the new bridge was replaced...and never had any bleeding....I did hold 1 dose for 2 extractions a few years back..but, got educated over the years on VR.Com and flamed by Ross ....I would think 1 extraction should not be more than maybe halving a dose..or not skipping at all..but, you have to find out more..from this new dentist. Bonnie

 

[KristyW]

Don't do anything different!

Don't do anything different!

Lifelove,

I work in a dental office & believe me there is ABSOLUTELY no reason to stop your coumadin/warfarin or to bridge with the lovenox. A simple extraction is just that. Think about it... there is NO WAY you're going to bleed an extraordinary amount from a tooth socket. Now it will look like it at times because any blood in saliva looks like you're bleeding a lot.

I would educate your dentist right away about this. He's putting you through undue risks and expense.

 

[warrenr]

tooth extraction

tooth extraction

Read the following links. Copy them and give to the dentist. If after reading them he still wants to have you stop coumadin, even with bridge, fire him and find a dentist that follows the guidelines. If the dentist tells you that the risk of clot and stroke is very low from stopping your coumadin tell him about my father's stroke from stopping coumadin for a screening colonoscopy.

http://www.acforum.org/iframe_pages/doc_2004_spring.pdf

http://www.triangleoms.com/data/anticoag_bierne.pdf

http://cc.msnscache.com/cache.aspx?q=3154973201912&lang=en-US&mkt=en-US&FORM=CVRE

http://www.cda.org/cda_member/pubs/journal/jour0700/complex.html

http://www.dentalimplants-usa.com/Treatment/drugs.html

http://www.dundee.ac.uk/tuith/Static/info/warfarin.pdf

http://www.healthservices.gov.bc.ca/msp/protoguides/gps/warfarin_manage.pdf

 

[Guest]

Abagail Adams, wife of the second president of the US, once underwent a blood-letting treatment where a gallon was drained from her. Whhen she was finished, she said that she didn't feel very good but suffered no ill effects.

The proof that this dentist does not know his/her business is that in effect you are being told that you will lose more than a gallon of blood. That alone should tell you that you need a new dentist. They could probably put a pistol uop to the tooth and shoot it out and you would not lose a gallon of blood.

Further proof is that it is standard to restart the warfarin the night of the procedure (even after many types of surgery) because it takes three days for it to begin to build the effect back up.

By stopping the warfarin the dentist is saying that he/she would rather that you had a stroke that some minon bleeding. So what if you are up most of the night with a socket oozing blood. Isn't that a far better outcome than possibly never being able to feed yourself again and winding up in a nursing home. It has happened. I have been an expert witness in a lawsuit against a dentist where this very thing happened.

Find someone with more skill and knowledge. The recommendations on my website that Ross referred to were issued in 1997 in the Journal of the American Dental Association. So you can be assured that this dentist is at least 9 years behind the curve.

 

[Tiffin]

Just my two cents after visiting my pacemaker doctor on Monday and telling him I have to go to dentist I broke a tooth also and need to have it taken out.

He said "oh you will need to come off your coumadin for 3 days before and maybe two days after"

My look must of said "Your crazy" because he then stated "it won't stop bleeding if you don't"

Even Doctors are totally lost to the effects of WHEN you should come off Coumadin.

Since my dentist retired I'm in the process of looking for a new one ESP one who knows about heart patients and their meds they take grrrrrrr.

 

[Guest]

I have found that Oral Surgeons are usually not afraid to do a simple extraction without stopping warfarin.