Oral surgeon will remove teeth with INR of 2

[MNmom]

Which meant absolutely nothing to me pre-surgery, since I figured I would figure it out when the time came. But when talking to my cardiologist about timing now to remove wisdom teeth, he remembered talking to my oral surgeon pre-surgery (which is when I wanted to have them removed- pre coumadin- but my heart was not in good enough shape to go through even sedation) and my oral surgeon stated he was comfortable removing my wisdom teeth with an INR of 2.
So technically, I would not need to go off coumadin, and get lovenox, etc. So I was all happy to hear that, but am now thinking, how does one go about aiming for an INR of 2? Would I need to lower my dose to be right at two - and how would I do that??? My range is supposedly 2-3, so maybe it could be a gradual and safe process? The thought of it makes my brain hurt.

Anyone else have to aim for an exact number for a procedure? Or is this really odd?

 

[dick0236]

Have you ever tried to hit a pheasant with a rock ? In my opinion, you'd be more successful doing that than hitting and staying at a specific INR. There will be little difference in bleeding whether you are 2.0, 2.2 or 2.5. Just try to get your INR toward the lower end if you want to placate your dentist. He won't know the difference.

 

[Ross]

You and your oral surgeon need to read this.

Conclusions. 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 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.
Clinical Implications. Dentists
should recommend that therapeutic levels of anticoagulation
be continued for patients undergoing
dental surgery. Practitioners should consult with the
patient’s physician if necessary to determine his or
her level of anticoagulation before performing dental
surgery.

 

[MNmom]

So Ross, you would recommend, based on the article, to leave the level where it is when I get all four wisdom teeth pulled? It is pretty much just extractions- they are all fully up- they dont need to dig them out or anything, whew.

 

[catwoman]

If I had a procedure in the wings requiring that I got my INR down to 2.5 (the cellar for MVRs), I'd whittle my warfarin down 5% at a time to see what the results are, chart them and keep on until I had 2 consecutive INRs of about 2.5. Then I'd schedule it, knowing how much warfarin it generally takes to keep me at 2.5

Now mind you -- I haven't had to schedule a procedure yet requiring my INR at 2.5. I might be off on my above guesstimate of how to get it there!

 

[Karlynn]

Are you having immediately problems with these teeth or are you just being told that they should come out. If it were me, I'd wait a few more months. You're only 2 months post op, your INR has had a hard time getting in range and being managed correctly.

I'd ask the oral surgeon what the risks were of you bleeding to death from wisdom tooth extraction and see what his response is. If all 4 teeth at once presents too much of a bleeding risk - then do 2 at a time - one side, then the next.

You're talking a matter of a few seconds between an INR of 2 and 3 when it comes to bleeding.

 

[Ross]

So Ross, you would recommend, based on the article, to leave the level where it is when I get all four wisdom teeth pulled? It is pretty much just extractions- they are all fully up- they dont need to dig them out or anything, whew.

Ross isn't recommending anything, the Doctor who wrote the article is basically saying there is no reason for you to stop Coumadin for any mouth surgery.

 

[MNmom]

I brought it up initially to my cardio since he had origionally said to wait three months after surgery, and after having read on one of these forums that the ideal is to wait 6 months- I wanted clarification...
My wisdom teeth are not bothering me, they are not infected, they are just crowded back in my mouth, which makes it difficult to keep clean, which means decay- they would rather pull than deal with a root canal, etc. So they are more of a nuisance than an emergency- so I will end up waiting the 6 months following surgery rather than 3...BUT I thought I would ask now while the question was still in my mind.
I am THRILLED to hear that I can continue to take coumadin and not mess up my range - hopefully it will not be an issue to get to the low side of my 2-3 range. I just hate to mess with it- I am finally waiting a whole 2 weeks to test now, rather than weekly. Maybe I am getting stable! I have also been really increasing activity, and have not noticed any drastic decreases in INR.
Ingrid

 

[Guest]

The blood loss from tooth extractions is almost always an inconvenience rather than a problem. Look at how much blood people lose from a gunshot wound and live.

There are several articles about vitreoretinal surgery (a needle in the eye) at INRs of 2.1 to 3.1.

I've heard pulmonary hypertension doctors say that they do not even worry about the INR when doing an emergency cardiiac catherterization. One put it this way - I save their life first then worry about the hematoma later.

But woe to (s)he who will mess with the teeth at an INR greater than 2.0