Does this sound right?

[Creed3]

Hi Everyone!
I have been waiting to hear from my doctor about what he wants me to do with my coumadin before my dentist appt. This is what he finally told me to do....

Cleanings: Stop coumadin the day before dentist appt. After the appt., start your coumadin again, that day.

Procedures: Stop coumadin three days before appt. and start taking coumadin again after the appt, that same day.

Does this sound right? I know some of you have written that you keep taking your coumadin like you always do, before a dental cleaning. The doctor keeps my INR between 2.0 and 3.0.

Thanks & Take Care!
Gail

 

[Ross]

Hi silly person!

Continue the Coumadin for simple cleanings. Don't stop for this alone. I've had mine cleaned, drilled, filled, and scaled while on normal coumadin therapy and there has not been any troubles at all. I think your Doc is wrong and you should print out and take the page from Al's site with you. I'm going to Al's site and get you the link for his dental procedures page. The only time you may need to come off the Coumadin is with mulitple teeth extraction or oral surgery. Check the link out below, it's updated!

http://warfarinfo.com/dentalprocedures.htm

 

[MarkU]

Hi Gail,

You really need to read the recent update that Al Lodwick did to his website and the related thread in this section, discussing the risks of discontinuing Coumadin therapy for dental procedures.

I for one would be very hesitant to discontinue my Coumadin for any routine dental work. The risk of having a stroke is too scary to me.

From the layman's knowledge I have of how Coumadin is processed by the body, I wouldn't think that discontinuing for one day prior to any procedure would have much effect anyway.

Mark

 

[LUVMyBirman]

Yikes Gail. Listen to Ross!!! You were given incorrect info!

The only time I stopped was when I had my wisdom's pulled. Back when bridging therapy with Lovenox was safe. I have read of others here lowering their INR's and safely carrying out extraction's too. Will have to look into that if that day ever darkens my door again

 

[Ross]

All dosage changes take 3 days to show a result so stopping a day before isn't going to change much of anything. I wouldn't risk it.

 

[Lorraine]

Hi Gail,

So far all I've had is cleanings since my surgery. I stayed on my Coumadin. I took antibiotics, I believe it was an hour before the procedures. I wouldn't go off the Coumadin if I were you. Did your doctor give you a prescription for antibiotics to take?

I believe others have had procedures done and stayed on their Coumadin too. You also should read what Al posted on January 3rd, 2003. "Risk of Stopping Warfarin for Procedures." Print it out and take it with you to your doctor and the dentist.

I know others have had different procedures so I'm sure they can help you out with their opinion and experiences too. Hope I helped some. Take care.

 

[Ross]

I was wlking around and cleaning up when I remembered to ask you if you were taking any antibiotics before the appointment. If not, you need to get ahold of the dentist and have him prescribe 2000mg of Amoxicillin or similiar, to be taken 1 hour before your appointment.

Glad you jumped in Lorraine! I nearly forgot that part.

 

[Creed3]

Yes, my doctor did write me a prescription for amoxicillin. I'm not sure what the dose is. I'll see when I pick it up. I will also be printing off a copy of Al's post. I did read it and that is why when my doctor gave me these instructions, it didn't sound right. I will definately print it and show it to him. My dentist will not give me an appointment until I do what my doctor tells me to do. If my doctor doesn't change his mind, my dentist will not see me if I decide to stay on the coumadin.

Thanks Everyone!
Gail

 

[Ross]

Just continue the coumadin and don't tell him you took it. It's really too bad that these health care pro's don't have it together when it comes to us rat poison people.

 

[Blanche]

Gail:
I'm sorry you're stuck between the doctor and the dentist. The only answer is that patients must educate their doctors and dentists. Albert's been on coumadin for 12 years and had regular dental visits, including one extraction. Never had a problem and never went off coumadin. There is an article that you might tell your dentist about. It is, "Myths of Dental Surgery in Patients:Receiving Anticoagulant Therapy," M. J. Wahl, Journal of the American Dental Association, January 2000, vol 131, pp77-81.
Al Lodwick quotes this article. I could not find the entire article on the web, but there is an abstract. If you email me through this board, I can email it back to you. The conclusions this study, which involved 950 patients and 2400 surgical patients was
"Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were below or within therapeutic levels.) Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientif fact, but seems to be based on its own mythology." The study also talks about 526 patients who had 575 interruptions of continuous anticoagulation therapy. "Five suffered serious embolic complications; four of these patients died." You might also check an article from the New York State Dental Association, entitled "Stop the Nonsense Not the Anticoagulants: a Matter of Life and Death" dated November 2002. I hope this link works. www.nysdental.org/publications/full_article-archives.cfm?ID=89

You might want to send these materials to both your doctor and your dentist. Most state dental associations have position papers about interrupting anticoagulation therapy. Your dentist should know of these. I have a feeling that if you present him with articles from his professional peers that he will insist that you continue your Coumadin. To do otherwise in the face of research evidence is clear malpractice.

I wish I could do better for you, but I am not computer savy and am so limited. If you wish, I'll gladly send you the articles above and others that I have. Gail, you have such a positive attitude that I know you will make this work for you. OOPS! I almost forgot, you might also want to use Al Lodwick's newest materials on stopping anticoagulation. www.warfarinfo.com/procedures
Best wishes,
Blanche

 

[Johnny Stephens]

Hi Gail, I've had a crown replaced while on Coumadin with no difficulty. My dentist has a standing prescription for the 2000 mg of Amoxicillin and I take it one hour before my appointments.

As an aside, I carry this card from the American Heart Association on the suggestion of my cardiologist (it's about the antibiotics, but not the Coumadin):

Wallet Card

The relevant portion for valvers is about halfway down: "Prophylactic regimens for Dental, Oral, Respiratory Tract, or Esophogeal Procedures."

 

[csutherland]

My Jerry had every tooth in his head crowned about 2 years before his AVR. Adjustments are still being made in his bite, etc., as well as some grinding, etc. and nothing has ever been said about coumadin. They do insist on him having the handful of pills 1 hr. before every app't though. He also had a checkup and
cleaning by his regular dentist since the AVR. Same deal. Oddly enough, I had rheumatic fever as a small child and about 15 years ago someone discovered that fact on a chart and now I have to take antibiotics every time before seeing the dentist.

I do have a question I'm going to post on another thread about a colonoscopy & coumadin. I read something a while back on here about it but wasn't concerned at the time.

 

[Ross]

Celia, you may want to inquire about a "Virtual Colonoscopy".
Check this link out!
http://virtualcolonoscopy.med.nyu.edu/vcinfo/whatis.html

 

[Rich]

Never went off Coumadin except once for an extraction.
There is no reason you should stop it for what your'e having done.

 

[Guest]

Any dentist who stops warfarin for a cleaning may as well plan to go to court naked, because that is about how much defense they will have if something happens to you.

There is even research now that almost anything can be done if the INR is less than 4.1

 

[Granbonny]

Does this sound right?

No, No, No, Noooooooo....Don't come off of coumadin for a cleaning. I had 2 seperate Peridontist DEEP cleaning..NEVER bled..did not take any invasive needle numbing (Was I brave ) Went straight to restroom to check and my teeth were just a shining and no sign of blood I took 4..500mg of Amox before...Now when I brush NO bleeding.....................Johnny Stephens. Is that you or Steve Martin?????Thanks Al..She told me I have a loose tooth in the back and if I ever want it pulled will check INR first..You are so What would we ever do without you....Bonnie

 

[Creed3]

Thanks to everyone! The information and the sites you gave me were great. My doctor told me to fax him the information I had regarding dental cleanings/procedure and coumadin. I just sent it today, so hopefully I will hear something from him by next week. I'm really curious as to what he will say about it. I'll let you all know how things go.

Take Care!
Gail

 

[joy]

Hi gail, I just started my coumadin, and my new doctor said that if I am going in for any procedure which requires drilling stop the coumadin 3 days before,but go on Lovenox instead. That's all the info I have for you!
Joy

 

[Christine]

i'm a little differnt than ya'll... before surgery, i've always been premed before dental procedures.. latest being 4 500mg caps one hour before and 3 caps six hours later.. now, my card wants me to take 6 caps one hour before and 3 six hours later.. i've had alot of work done over the years and test showed a past infection hit my valve which I think spead up the stenosis..

but my dentist is very comfortable working with coumadin patients.. he's always ahead of his game so to speak.. i was told that i shouldn't stop or change coumadin unless i'm having major dental work (ie:extractions, gum surgery) - i do bleed alittle longer or quicker, but they know my situation and deal with it by applying pressure and taking their time..

hope that helps..

christine

 

[terry40]

Johnny stephens

Johnny stephens

My PCP and dentist have a copy of that AHA card that was given to me by my cardiologist, inreference to antibiotics,
but this coumadin will be new to me.

Before I had surgery the cardiologist group needed a dental clearance, I also got my bi-annual cleaning, so I won't be due for a while, I'll have to print out the info on Al's site for future refences.

I thought they increase the antibiotic dose, when the valve is replaced with a mechanical prosthesis. Something else for me to check out.

Terry40