Oral Surgeon

[annamdg]

Tomorrow I am supposed to go off Warfarin Sodium for a wisdom tooth/rotten half tooth by wisdom tooth removal which will be on the 19th of this month.

Needless to say, I do not want to stroke out. My cardiologist did not act like he would ever agree to such awhile back. Though, suddenly he and the oral surgeon have come to this arrangement. I am doing my best not to get angry, though I am more concerned on having a stroke for this.

I am beginning to freak out a bit as I have not been off warfarin before.

 

[Ross]

Well the likelihood of having a stroke is very small, but it's still very unnecessary to come off of Coumadin for one extraction. It can be done safely as long as your INR is under 4.0.

I've got a document posted somewhere here from the JAMA ADA about the myths of Coumadin in dental surgery. Perhaps you should copy it and take it to your oral surgeon.

 

[Ross]

Here is the post with the link to download the .pdf file:

http://www.valvereplacement.org/forums/showthread.php?34843-Tooth-extraction....&p=450993#post450993

 

[annamdg]

I forgot to mention that they wanted me to go off of it starting tomorrow up until the 19th. That is safe ?

 

[Ross]

Not without bridging you with Lovenox. Of course, you probably wouldn't need to start the Lovenox until the 18th or 19th. Which valve or valves are involved here?

 

[annamdg]

Hi there Ross,

Thank you for responding. My apologies on the delay, had to go get something to eat. There hasn't been any mention of Lovenox. In the beginning thought they were going to use Heparin.

The valve involved is the mitral valve, mechanic St. Jude one.

 

[Ross]

With Mitral, most definately bridge. Heparin or Lovenox, but you need some protection until your INR is therapeutic again. There is no need to come off of Coumadin in the first place, but I know what it's like. My cardio backpaddled on me also. Try telling your oral surgeon that you will not come off of Coumadin, but you'll try to get your INR down to 2.5. See if he'll budge. Unless he plans on making you bleed more then a gunshot wound, local measures are all that's necessary to control the bleeding. You might want to see Woodbutchers thread. He just went through it about 2 weeks ago.

http://www.valvereplacement.org/forums/showthread.php?34843-Tooth-extraction....

http://www.valvereplacement.org/forums/showthread.php?34843-Tooth-extraction....&p=451403#post451403

 

[olefin]

I had an old root canal go bad, the Endodontics had to cut the cracked root off below gum in the bone. It took 3 stitches to close the hole. He first said I'd have to stop warfarin for 5 days. Told him I couldn't do that... then he surprised me and said OK. I lowered my INR down to 2.2 for the day of surgery, I was shooting for 2.5. He said there was no more blood than someone not on warfarin.

 

[annamdg]

@Ross thank you again, I will check out the information you have provided. It just doesn't make sense to risk a stroke.

@olefin Definitely too long. I know that my INR stays below 4.0 ... it is not even 3.5. That is good to hear on how it all worked out.

 

[olefin]

annamdg,
I failed to post that I never asked my cardiologist... I was feeling he might tell me stop warfarin and switch to Lovenox. But the next time I see him I'm going to see how he feels about dental surgery. I'll take a copy of "Myths of Dental Surgery", just in case.
I later asked my family doc and he said, stop warfarin and start Lovenox. I didn't say I had already had the procedure.
I gave my dentist a copy of "Myths of Dental Surgery".

 

[annamdg]

Shakes head at those that recommend coming off blood thinners. It certainly does not comfort the patients. It is more of a liability thing for the professionals than for the patient. In my opinion it should be more of a safety thing for all involved. A stroke can be a lot harder to come back from than slight bleeding.


Mentioned on the thread Woodbutcher posted , ' On the plus side, I am supposed to be knocked out for the procedure. The oral surgeon said it should not take him more than ten minutes. '

Also; I am going to ask if I can keep the tooth in order to see it afterwards.

 

[Ross]

Tell him this, you can always replace blood cells. You cannot replace brain cells. He should be able to figure that out. 10 minutes huh? I had a grandiose oral surgeon too. I took him over an hour to get all 4 of mine. One day, I went in for a denture adjustment and he was working on another persons wisdom tooth. Took him better then 30 minutes to get it out. I heard him say he wasn't going to do anymore wisdom teeth, he had enough!

 

[annamdg]

Yeah ... I am not so sure how true the 10 minutes actually is. Wowzers, that was a long time Ross. As long as all goes well; I should be back here posting. I am hoping I don't get butchered.

 

[annamdg]

I am out of surgery, thank God no stroke. Was not butchered. Was just a bit nervous. I think the question you all may be wondering is did I stop the warfarin ?

The answer is on Saturday, I took my normal dosage. Sunday and Monday half the dosage and Tuesday no dosage.