First Time

[Granbonny]

I have been asked to hold my coumadin (warfarin)...for 3 days..prior to my dentist wanting to extract 2 back teeth. One upper and one lower and a small filling on Nov. 17th.. I said, are you sure and he said. YES..don't want to you bleed. That would make me hold a 5 mg. on Friday, a 5 mg. on Sat...and a 2 1/2 mg on Sunday... Anyone else ever held for 2 extractions. What do you think, Al. Dentist says he does it all the time...Will ask my clinical nurse tomorrow. Had my regular cleaning today (every 3 months) no bleeding. Medicate 1 hour before..Bonnie

 

[fyrfytr]

Hey Bonnie,
I would be concerned also. I think you are doing the right thing and asking someone else about it. I hope all goes well with you at the Dentist.
Take Care

Dave
_______________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical

 

[JimL]

Bonnie, keep asking questions. I wouldn't want to hold for three days!
Here's a quote from a document on the American College of Cardiologists' site, mentioning something about dental work I haven't seen before:

"Finally, for patients undergoing dental procedures, tranexamic acid or e-aminocaproic acid mouthwash can be applied without interrupting anticoagulant therapy."

I hope that helps. Perhaps Al will tell us what it means...

 

[Granbonny]

Thanks Jim

Thanks Jim

Your wife works in a dentist office? My dentist is a huband wife team..Great staff..Warm and friendly. They are really concerned about my gums. Since I have been rotating every 3 months between them and the Periodontist (next door) my gums have never bled...Stay on warfarin during the deep cleaning..Still do not bleed. After my VR.. I would wake up with blood in mouth..during day..ect. Went to ER..scared and they told me I was normal. Had to be the gums..Would have never thought I could have that much blood in mornings.. After first visit with periodontist..Never bled again... Now, I have pearly whites. Just my age (63) that these back teeth that I don't need ..need to come out. I told him..I don't want to have a stroke. He said, you won't.I do it all the time..Will ask Cardiologist tomorrow. Hubby's time now for followup..after having a stress-echo done..O.K. but his heart is not pumping enough blood. Has to quit smoking and drinking He put all his pipes away but still has a little nip. My INR was 3.1 today...always in the last 6 months right on.. I'm wondering if I hold..can I take my warfarin that night? After extractions. Will wait to hear from Al, out expert coumadin guru I missed a dose a few months back (on trip) waited 3 days and was still in the 3 range. Bonnie

 

[Karlynn]

Hi Bonnie,
Your post caused me to do a little web research because I thought that tooth extraction is a real possibility for all of us. Most of the dental sites seemed to go with stopping Coumadin for 3 days prior to extraction or root canal. But what causes me to wonder is that it doesn't allow for what your INR is prior to stopping. A few places mentioned using heparin right after extraction, or in preparation for extraction since it wears off much more quickly than Coumadin. The sites said it take 3 days for Coumadin to leave your system.

The sites I saw were all dental sites, not cardiology sites. Would like to know how they weight in. Let us know what your card. says if you talk to him.

Karlynn

 

[tommy]

I did the Lovenox routine for a crown. It was a precaution, but I never bled. My guess is that my dentist and cardio would opt for Lovenox for an extraction. I'm going to have a bridge installted in a few months. It's basically two crowns with the false tooth suspenede between. I'll post what happens.

For a wide area excision, the surgeon and my cardio negociated and I held Coumadin for 2-3 days - wish I could remember exactly.

My cardio wants to be involved in every procedure. My suggestion is to check with your cardio.

 

[Blanche]

Many dentists continue to require patients to hold warfarin/Coumadin before dental procedures including cleaning, crowns, extractions, et. When they do this, they are flying in the face of current research and can put their patients at risk for serious complications, including strokes. If your dentist tells you to withold anticoagulation, ask if she/he has read the following:

Myths of Dental Surgery in Patients: Receiving Anticoagulant Therapy, M. J. Wahl, JADA The Journal of the American Dental Association, January 2000, Vol.l3, No.1, pp.77-81(5).

Dr. Wahl more than 950 patients who underwent more than 2,400 (dental) surgical procedures. He concluded, "Serious embolic complications, including death (4 patients died), were three times more likely to occur in patients whose anticoagulation therapy was interrupted than were bleeding complications in patients whose anticoagulation therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology.

 

[Sunshine susan]

I am getting ready to have two wisdom teeth extracted--both will be "pulls" as neither are impacted. My cardio said there was no reason to stop the coumadin, that a lot of dentists want you to because THEY don't want to be bothered with any bleeding. But it is no big deal for the patient. Also sort of FYI, a used and squeezed tea bag can be used as a "local" coagulant on the site of the extraction or other dental work. It really works and doesn't taste bad either. Susan

 

[Ross]

Blanche do you have a card catalog system at your house or something? I think you need to set up a server with titles of things you have knowledge of. Your good, real good. In fact, you scare me.

 

[Blanche]

Ross:

It's Halloween week, you're supposed to be scared, but certainly not of me. I'm a pussy cat. The card catalog is in my head and my very messy favorites files flow over with articles and research on topics related to anticoagulation and strokes. When it comes to medical issues and procedures, my family seems to be the victim of "Murphy's Law." So many of us here at VR.com have been hurt because of lack of information too. If this board had been available years back, or if I knew it existed in 2000, my dear one might have avoided many of the difficulties that he encountered.

Actually, I'm more like the pack rat than the kitty. I go around and pick up this and that which I think I might need (like articles and info on dental work and anticoagulation) and stash it away for future use. And, like the pack rat, I try to leave or put something in the place of that which I collect. So, if anyone is in need of research info on anticoagulation, I might have just the article or source for them. I'm always willing to share.

Incidentally, the article that I referred to is one that came from Al Lodwick's site www.warfarinfo.com. Al Lodwick's materials are the very best that I have found. His site is the first place I look for anything that has to do with anticoagulation.

Happy Halloween to All,
Blanche

 

[Karlynn]

Blanche,
Thanks for pointing out the article. That is important information to be armed with.

Karlynn

 

[Granbonny]

Will go off coumadin

Will go off coumadin

For my 2 pulls on Nov. 17th. I saw my Cardiologist in Hallway yesterday and asked him..he said..yes, go off for 3 days..Let my dentist decide when to restart..as..if there is no bleeding when I leave office..can start up again soon...Asked my husband's cardiologist..he said same thing..( I have seen him before)..and told my clinical nurse, Ashley..and she said..Yes, that is what we tell all our patients to do.........so I trust my dentist, these 2 cardiologist and my clinical nurse.. Bonnie