Dental extraction with INR of 4.7

[sue943]

I just thought that it might put some minds at rest to post this.

This morning I went to the hospital dental department as I had a molar which had partly broken, they phoned to ask me to be there for 11.15 as the dental surgeon had a cancellation so could see me then. I took some antibiotics with me just in case.

I was called in at 11am, he examined the tooth, ex-rayed it, made me take my antibiotics then told me to go to the main hospital and have my INR checked and that he would start the extraction at 12.10.

After my test I was called back in and he said that my INR was 4.7, then proceeded to inject me with local anaesthetic. The tooth was being really stubborn but he finally managed to get it out, and in one piece. He then inserted a few stitches and left me biting on a wedge for a while.

By 12.45 I was on my way back to the carpark having been told not to do any exercise for the remainder of the day, nor heavy grocery shopping. Tonight I am to rinse the area with salt water.

There is absolutely no bleeding whatsoever.

My range is 3.0 to 4.0 so I will probably skip my 4.5mg of warfarin today.

 

[Protimenow]

It seems like that stitch was a great idea. I had a tooth extracted a few years ago - my INR was probably around 3.0 or so - and with no stitches it seeped for at least an hour.

It sounds like your dental/medical team knew exactly what they were doing.

 

[pellicle]

Awesome story (sorry you had an extraction though).

I am sort of jealous that you need so little warfarin to get such an INR. I need 6 ~ 7mg a day to get to 2.5

All the best

 

[sue943]

This is the second molar that I have had extracted since being on warfarin, the other one was a bit loose, the last time my INR was about 3.6 and he stitched then too and again I had no bleeding at all.

It is now more than nine hours since the extraction and still no sign of any bleeding. I won't say that it has been completely painfree since the local anaesthetic wore off but he really had to pull very hard indeed to remove the tooth so discomfort is understandable. I am taking paracetamol to kill the discomfort.

The hospital insist that I have all my dental work, checks, cleaning etc done at the hospital, there is no charge and they even give me high flouride toothpaste for free. The dentist that I see contacted my cardiologist when I was first referred to them so that they made joint decisions on my care.

 

[AgilityDog]

Yep, we're not gonna bleed to death.
Monday, I had a very small basal cell carcinoma removed from my upper arm, with an INR of 4.2 (Probably had something to do with the antibiotics from the dentist a few days before, but that was unusual to get that reaction. I don't usually).

The Dermo. knew I was on warfarin, and I told her my INR was a tad high. No big deal.
The Dr. gave me a 1 inch + incision, and about 7 stitches, to remove a spot the size of a pencil eraser in diameter (at least on the surface).
Yes, I bled. Rather a bit, and she had to cauterize, and even tie a knot around one stubborn blood vessel that would not cauterize and stay sealed. But she expected it, and was prepared for it.

But I DIDN'T die!! I didn't need a transfusion, and I wasn't dizzy. It was a tad messy, and of course I have a bruise.
But seriously, that is FAR larger than most dental extractions. So Seriously, folks. This drug is not a death sentence, and I wish people, including medical personnel, would just CHILL.

 

[Protimenow]

Amen to that (wanting people to CHILL). Perhaps eventually professionals will finally understand warfarin -- but this will probably happen at about the same time that they find some other medication that costs a nickel a dose and takes care of clots forming on valves.

I've had some dental issues -- and had to choose between extraction and repair (root canal, crown). It's apparently less expensive, in most cases to get the crown than it is to get bridge work and all that other crap that they put in so you can still look decent and chew corn (or somethng). I'm just speaking from personal experience -- and I'm missing a number of teeth -- but I suspect that if there's a choice between extraction and 'repair,' 'repair' may be an overall better choice.
(That said - I wonder if any of us have had dental implants, if if there's much of a bleeding issue with those things)

 

[pellicle]

This drug is not a death sentence, and I wish people, including medical personnel, would just CHILL.

+1 on that one

 

[marc_kowal]

Around Chirstmas last year, I was installling a new microwave and my hand slipped while installing the new mounting bracket. I wound up cutting an approx. 1/4" circle of skin from my knuckle. It didn't cut completely off, so I flipped the skin back on the finger, my wife helped me clean it, we wrapped it and I went to the ER. By the time the nurse unwrapped it, it stopped bleeding. All they did was clean the area some more, apply ant-biotic ointment, a finger splint so I wouldn't bang it and I was on my way. I did not bleed out, nor was I too concerned about it ( I even drove my self to the ER), but since this was my first cut since being on coumadin, I went to the ER because I didn't know what to expect.

Coumadin can be a pain in the arse at times, but it's not a death sentence.

 

[Protimenow]

The INR numbers are supposed to be related to how long it takes to clot, compared to normal (non-anticoagulated) state. So - if you would normally take 15 seconds for a small incision to clot (an INR of 1.0), the same incision would take 20 seconds with an INR of 2.0, 30 seconds with an INR of 3.0, 40 seconds with an INR of 4.0 -- you get the point. For small cuts, this really isn't that big of a thing -- applying pressure to slow the blood flow - and often just going on with life as usual - is pretty much all you need to do. This is why a blood draw - where a pretty decent sized hole is made in an artery, usually isn't that big a thing as long as there's a small cotton ball and some pressure applied. (I had one blood draw, by a clumsy phlebotomist, and DID have some seepage, but it stopped after a couple minutes).

With a bit of help, I once dropped a 50 pound slab of marble on my ankle -- it swelled quickly, but didn't explode. Ice compresses kept the swelling in check, and I had a nice, multicolored bruise for a week or two.

Warfarin is NOT a death sentence. There are many people who are on warfarin who live what some may consider somewhat dangerous life styles, and it doesn't really change the way that they live.

A lot of people -- especially those new to warfarin, think that it'll dramatically increase bleeding and risks of hemorrhage. Just keep testing (I advocate for weekly self-testing), watch diet and meds, and live your life. (And - FWIW - it can be a lot worse if your INR is LOW, and you let it stay low for more than a few days -- I know from personal experience).

 

[carolinemc]

The reason it was up was due to the antibotics taken before doing the INR, bad thing to do. He should have done the INR before you took the antibotics, Never skip a dose off warfarin without medical advice. That would show up low on INR at some point. Never do that, tell dentist before dental procedure, do the INR before antibotics are taken. Talk with your cardio about that and skipping a dose. At least you did not have a major bleed, you were probably in your normal range anyway. Be czareful next time. Hugs for today.

 

[Protimenow]

One missed dose of warfarin isn't going to kill you, as long as you're in range before you miss it. It's staying BELOW range for DAYS that can cause the strokes. (I know - my meter told me that my INR was higher than it actually was. For one or two days, according to some of the material that I've seen, the risk of being out of range is pretty low -- as long as you bring the INR back in range quickly.