Has Lovenox been reinstated for anticoagulation in valve patients?

[LUVMyBirman]

Was wondering if anyone has recently used Lovenox for anticoagulation "down time"?

Last year I had a root canal on a molar. The original tooth was cracked when my wisdoms were removed. Nice. It was crowned after the canals........now infection. They want to do something called a
"crown lenghting". No guarantee they say. Since infection is the enemy and this is a back molar....I am pushing for an extraction.

Thanks.

PS. They will not do this on the Coumadin. Tried my hardest.

 

[fyrfytr]

Hey Gina,
Sorry to hear you are having problems with your teeth. That is one thing I hate and that is going to the Dentist.
I think you are going to find that some Dentists are OK with working on people on coumadin and others aren't. You might ask your PCP or Cardiologist if they would talk to your Dentist and explain things to him.
I hope you get things taken care of.
Take Care

 

[Ross]

Al will have to confirm, but my Cardio and I talked about this and he told me he would recommend it as bridge therapy, so I assume the answer is yes.

 

[LUVMyBirman]

Thanks guys I was told yes by my cardio on the Lovenox about six months ago. This was after reading "somewhere" that it is standard once again for valve patients. There was a brief FDA bilp....then no standard statement following Anyway...I have used Lovenox may times in past years for various invasive proceedures. Always like to check in with you all to see what is going on out there. It's better than a second opinion!

Have not had a need for it while on BCBS of IL. Just hope it's covered as the injections cost around $100 a pop It usually takes close to two weeks for my INR to come up too! Can you imagine if it were a cash deal a x2 daily! !

 

[Karlynn]

Gina,
My card also said she would use Lovenox as bridge therapy, at my last appointment about 3 weeks ago.

 

[LUVMyBirman]

Looks like the numbers are in favor! Aside from popping myself twice a day......it should be a piece of cake. Beats being locked up in the slammer for a Heparin drip!

 

[Guest]

It has sorta been approved.

The warning not to use it was removed.

But there is no standard for bridge therapy. There probably never will be. The time until the patent expires is too short to make it economically feasable to do the test.

 

[LUVMyBirman]

Thanks comforting Al They just passed me on to an oral surgeon. Maybe he will be willing to take it on "reducing my Coumadin" staying on at maybe 2.5 for the proceedure. I do recall others in the group having oral surgery on it! Comments????

Will keep you posted. Thanks.

 

[Guest]

You can print my recommendations for dental procedures at various INR levels at http://www.warfarinfo.com/dentalprocedures.htm

 

[Blanche]

Gina:

Al had surgery on one tooth last month. Apparently he developed a pocket that needed to be scraped out and the periodontist had to make two cuts to get at the infected area. At first they wanted him to go off his medication. I provided materials from Al Lodwick's book and a couple of articles. Still, that did not convince the periodontist. So, he did his own search. I believe that he has dental articles on Silver Platter. He found the articles Al Lodwick referenced and he also found three that I did not have. Two of these are not on the net. But, the article, "Periodontal Management of Patients with Cardiovascular Diseases," is. It has a whole lot of information that might be of interest to your oral surgeon. I'm leaving the link here. The article can also be found in the reference section on this board.
http://www.perio.org/resources-products/pdf/23-Cardiovascular.pdf

Al's procedure was done with INR=3.2. They wanted the INR to be between 2.5 and 3.0, but said 3.2 was close enough. He had no bleeding problems at all. Hope this helps you.

Kind regards,
Blanche

 

[LUVMyBirman]

Hi Blanche!

Thank you very much for the information! Will pass this on to my oral surgeon. Not a closed case yet. Almost have him talked into doing it on a lower INR. He needs to speak to my cardio as well.

Did Al's "Pocket" happen to be below a restored tooth, i.e. crown? Did they have him on maintenance antibiotics. They mentioned pockets can attibute to systemic infection. Funny thing is......they can't see anything on the x-ray!

Well.......now I am certain my Coumadin will be messed up for the next month now! No trips planned in the next 4 weeks.......so I have time. Just a pain in the

Thanks!

 

[Blanche]

You got it!

You got it!

Gina:
Yes, the pocket was under a crown. The periodontist also questioned a gap at the margin of another crown. Al's dentist sealed that one today. Given Al's history of endocarditis and stroke, you bet he was on antibiotics. He has to go the route of injections or infusions, followed by oral antibiotics, after every procedure. His INR is all over the place for at least a month after dental work.

I'm also sending a link, from BenchmarQ Healthcare Systems, Oral and Maxillofacial Surgeons in Atlanta. Perhaps your oral surgeon will be swayed by experts in his field. A recent article that caught the attention of our periodontist is "Lack of scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment," Arthur H. Jeske and George D. Suchko, Journal of the American Dental Association, Vol. 134, November 2003, p.1492-1497. It is not on the net. If you like, I can send you a copy.

http://www.benchmarq.net/Pages 2/edu_16.html

Kind regards,
Blanche

 

[ShezaGirlie]

Hi Gina,
I had a wisdom tooth pulled while on Coumadin. No way would I have done it otherwise. I printed out Al's recommendations and presented them to my Dentist. He was impressed!

 

[LUVMyBirman]

Blanche,

Thank you again. Having a hard time making my decision. To save it and have the crown extension where they try to releive the pocket. They told me no guarentee. Money is not an object when it comes to ones health....but a dice roll on a $700 proceedure and they may have to pull it anyway
This same tooth cost me $1,500 last year on crown and canals. Rest of my mouth is in great condition. Alway have my cleaning every 6 months. What is upsetting is that another oral surgeon down south cracked the tooth while removing a wisdom tooth. Otherwise, I would not be in this position!

Did Al's pocket fully heal? How long was he on the antibiotics? That is my whole deal. If it does not work the infection is still harboring. Makes me lean towards extraction.

 

[Bryan B]

Hi Gina,

I can't help you with the Lovenox question but just wanted to share my experience with my bottom back molar and wisdom tooth (I have both of my bottom wisdom teeth). I had to get get both the molar and wisdom tooth next to it crowned before my heart surgery, but I continued to have some pain back there and was running out of time before surgery. My dentist sent me to an endodontist who used "micro endodontics" and was able to do a root canal on my wisdom tooth. I don't know if this will help, but you might want to check into this type of dentist. I found it amazing...he used microscope lenses on his glasses and everything was magnified on an overhead screen I could watch. It was virtually painless and it cured all the pain I was having in that tooth. I hope everything turns out ok for you!

BTW, he charged 1,000 for that one root canal!

 

[Guest]

The article by Jeske & Suchko that Blanche Mentioned

The article by Jeske & Suchko that Blanche Mentioned

Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment.

Jeske AH, Suchko GD; ADA Council on Scientific Affairs and Division of Science; Journal of the American Dental Association.

J Am Dent Assoc. 2003 Nov;134(11):1492-7.

Department of Integrative Biology and Pharmacology, University of Texas Health Science Center at Houston Medical School, USA.

BACKGROUND: There is a widespread belief among dental practitioners and physicians that oral anticoagulation therapy in which patients receive drugs such as warfarin sodium must be discontinued before dental treatment to prevent serious hemorrhagic complications, especially during and after surgical procedures. OVERVIEW: The authors examine the scientific basis for properly managing the dosage of anticoagulants for dental patients who are receiving anticoagulation therapy. The authors review the appropriate laboratory test values to which dentists should refer when evaluating for dental treatment patients who are receiving anticoagulation therapy. The authors also review clinical studies, published within the past five years, that focus on the frequency and degree of hemorrhagic and related complications among dental patients who are receiving anticoagulation therapy orally to prevent thromboembolic events. CONCLUSIONS AND CLINICAL IMPLICATIONS: The scientific literature does not support routine discontinuation of oral anticoagulation therapy for dental patients. Use of warfarin sodium as it relates to dental or oral surgical procedures has been well-studied. Some dental studies of antiplatelet therapy are consistent with the findings in warfarin sodium studies. Dental therapy for patients with medical conditions requiring anticoagulation or antiplatelet therapy must provide for potential excess bleeding. Routine discontinuation of these drugs before dental care, however, can place these patients at unnecessary medical risk. The coagulation status--based on the International Normalized Ratio--of patients who are taking these medications must be evaluated before invasive dental procedures are performed. Any changes in anticoagulant therapy must be undertaken in collaboration with the patient's prescribing physician.

PLEASE NOTE THAT THERE IS AN ERROR SOMEWHERE IN THE ARTICLE. THE PLACE TO FIND THE CORRECTION IS LISTED BELOW. YOU CANNOT GET IT UNLESS YOU ARE A SUBSCRIBER. THE ERROR MAY NOT APPEAR IN THE ABSTRACT ABOVE.
Erratum in:
J Am Dent Assoc. 2004 Jan;135(1):28.