Dental Extractions

[amcara]

Hi there everyone,

I need to get two teeth extracted (one is a wisdom tooth and may involve cutting) and I have a St. Jude's Mechanical Heart Valve. I always take Amoxicillin (4 500mg) before appointment.

What would you all do?

I read on Al's site about someone bleeding for 12 hours with 3.0 INR range. I just don't want a stroke or something.

Okay, here's the thing...anyone ever heard of there doctor suggesting instead of warfarin...Lovenox shots (2 a day)? Or, go off warfarin...and cardiologist said risk stroke. Or...go to the hospital and get IV Heperin and teeth removed there?

To me...I just don't understand why the warfarin cannot be continued and the dental extractions done at my local dentist. Please...advice.

 

[ALCapshaw2]

Hmmm... I don't remember the recommendations for extractions.

Our resident Coumadin Clinic Director, AL Lodwick, has a website ( www.warfarinfo.com ) with everything you need to know about managing Warfarin. Just scroll down the list of topics until you find the one on Dental Procedures.

Lovenox and Heparin are the two options used for Bridging Therapy. They both have shorter lifetimes so are used for 'invasive procedures / surgery'.

I just went through a Lovenox Bridge for some GI procedures. The protocol involved taking my last Coumadin 4 days prior to the procedure, skipping a day, then starting the Lovenox injections with the last one 24 hours before the procedure and the next one the night of the procedure. Lovenox (twice a day) was continued for 4 days and then my INR was tested. Coumadin was started the night of the procedure with at an accelerated and tapered rate for 4 days until the INR test.

Heparin can only be administered in a hospital for 3 or 4 days before and after the procedure and requires regular blood testing (every 6 hours I think).

'AL Capshaw'

 

[kerri73]

It's been a few years now, but I know when I had my wisdom teeth removed, I lowered or held my coumadin dose for a day or two prior (maybe that wasn't such a good thing?) and it was done in a hospital as outpatient (but not with a heparin iv or anything, just because of the nature of my situation).

I came through just fine, and returned to my normal coumadin dose after the procedure.

That's a toughie because there will be some bleeding with that and I understand their reasoning for having you lower your dose.

Good luck!
Kerri

 

[Guest]

Please see my dental chart at http://warfarinfo.com/publications.htm
Feel free to copy it and take it to your dentist. It appears to be sort of a tossup whether to stay on warfarin or go to bridge therapy. You are very fortunate to have a dentist who will consider bridge therapy. Too often, people are put at risk of spending the rest of their life paralyzed from a stroke for even a simple cleaning.

 

[MarkU]

Had an extraction last June. Did it without altering my Coumadin dosage. My dentist knows I'm not a "bleeder" and didn't have any problems with it. Kept some guaze on the site for an hour or so afterwards and everything was fine.
I just take Clindamycin beforehand (I'm allergic to penicillin).

Ever wonder when the last time was that somebody bled to death in a dentist's chair? Maybe if the dentist used a chainsaw for extractions...

Mark

 

[ClickerTicker]

Careful with extractions - I almost certainly ended up with endocarditis after an extraction. Now I have to have IV antibiotic prior to any dental procedure - even hygenist.
Double-check with your dentist that the Amoxicillin prior to the procedure is adequate. Ask if you need follow-up antibiotics until the thing has healed up and there's no further risk of infection getting in.

 

[amcara]

I appreciate everyone's time to respond to me, thank you. I see all are in favor of the antibiotics and definately bridge therapy of some kind. I don't usually bleed very much even at the range it's in. Well, I don't know what will happen, guess I'll wait and see. I only asked those questions before because I've never had this done.