Coumadin Use

[Dan Campbell]

I had a aortic valve replacement (St. Jude) in 1998. In the next week or so I plan to have 2 teeth removed (wisdom & adjacent tooth).
Does anyone know if I should continue or stop my daily coumidin use for this proceedure. My monthly INR readings have been from 2.2 to 2.6 on a fairly regular schedule.

Any input is appreciated.

Dan

 

[Karlynn]

Hi Dan, and welcome!

Your question is a hotly debated one. What does the oral surgeon say? We have a most valued member on our site, Al L. He is an anti-coagulation expert and has his own site www.warfarinfo.com . He will probably weigh in here on your question, but in the meantime, I recommend going to his site and doing some exploring on this issue.

 

[Guest]

Multiple extractions are safe at any INR below 1.9. You should probably hold your warfarin for only a day or teo at most and have the INR checked just before you do the extractions.

Look at my website http://www.warfarinfo.com/dentalprocedures.htm

The information on the chart is now 7 years old and from the American Dental Association. I have permission to copy and modify it.

I am also giving a talk next week about this and I just looked up the Coumadin package insert. It now cautions against stopping warfarin for an extended period of time for extractions.

If your dentist wants to stop for longer than this, then you should ask for a referral to an oral surgeon who is more experienced.

Even if you have oozing from the site that lasts for 24 hours, that is nothing compared to being paralyzed or wrecking your valve.

 

[JimChicago]

I wonder if - after reading Al's info at his website - it may be a good idea in some cases to do extractions one at a time so that it is a simple extraction procedure?

Also I guess it would be a good idea to discuss with the dentist what 'local measures' will be used as Al lists them as "local measures (sutures, oxidized cellulose, microfibrillar collagen, topical thrombin and/or tranexamic acid.)" I remember from some other thread a "tea bag" was mentioned too.

 

[LUVMyBirman]

Hi Dan,

I had three wisdoms pulled at once. Off the Coumadin and had me on Lovenox injections. Which is similar to Heparin. This way I was only uncovered for a very short period of time vrs. one week or more until the INR levels up again.

 

[Raverlaw]

With two adjacent teeth, one procedure will be better than two separate extractions. Your surgeon will probably need to use a suture or two. Even on a normal extraction (a person without Coumadin) some slight seepage can be expected for up to three days. A large stack of gauze pads (change every 20 minutes) will help you control bleeding- just roll 'em up, stick 'em in there, and bite down. Wet tea bags also work well when the bleeding starts to slow down a bit.

 

[Shirley]

Hi Dan,

Almost 2 years ago Jim gave me a chart he had copied down - I think from Al's web site. I took it to work and gave it to the dentists I work for and also to some other dentists I know. It was a very good reference and had a lot of helpful info. We believe that in most cases it is harder on a valve replacement patient to go without the coumadin. There was something about all the possible complications of going without coumadin being worse than the potential for bleeding. Who is planning on doing this procedure for you - your dentist or an oral surgeon?

Shirley