Tooth Extraction Protocol

[KristyW]

Al,

I hate to bother you with this kind of question, but my PCP doesn't seem to be very informed on some of the anti-coagulation issues.
I am in need of a simple tooth extraction. I am on 40mg of warfarin per week.
My INR runs around 2-2.5 (can't convince my PCP to let it stay around 3.0)

What would be the anti-coagulation protocol for the simple extraction?

I've put in a call to my PCP, but I'm not sure that I'll even get a call back. I'm also going to call my cardiologist to double check with him.

Thanks

 

[LUVMyBirman]

Hi Kristy

I had my wisdom teeth extracted last year. They removed me from the Coumadin three days prior. In interim I used Lovenox injections'similar to heparin' to keep me properly maintained until my levels returned to normal. Which....took close to two weeks from start to finish.

Have heard that some doctors just tell you to cold turkey it on the Coumadin. Personally, I would rather deal with the sub q injections than potentially having an irreversible episode.
I did find out that the standard antibiotic regimen that we use for cleanings held true for the tooth extraction's. Formally they would have you on IV antibiotics. The AHA has since changed standards.
Have also heard of individuals staying on the Coumadin for extraction's. Do not know what the outcome of that was? Personally, I would not want to risk it. I am sure your doctor will decide the best solution. It seems like a lot of hub bub. Honestly, it's not bad at all.

 

[Ross]

Al has this posted on his site. I don't know if you've seen it yet, but until he comes along, it may help with your question.

http://warfarinfo.com/dental-procedures.htm

 

[Guest]

Thanks, Ross

One lady with a valve got very mad at me because I recommended that she not discontinue warfarin before an extraction. She was up all night holding a gauze pad on her socket. I said, "So? How inconvenient would it have been to have your valve replaced or have a stroke." I guess she never did see it my way - she quit coming and went to another clinic because it was closer to home. But they moved the clinic and she still didn't come back.

I did a malpractice consultation where I was on the defense team of a dentist who had someone have a stroke in the dental chair. We made a successful defense because it was before an article was published in the journal of the American Dental Association saying that warfarin should be continued unless there was a high risk for bleeding.

The American College of Chest Physicians (they set the standards for warfarin use) recommends the same thing. Physicians and dentists want to avoid bleeding but they are actually more liable for malpractice by stopping warfarin than continuing it.

 

[KristyW]

Gina, Ross & Al,

Thanks for your responses!

My dentist and I had discussed this. He is from the "old school" where the warfarin was withheld, but he also had heard about not changing the warfarin dose. I explained how I would rather not withhold if possible because I'm much more afraid of a clot than I am of bleeding. Bleeding can be controlled. My dentist agreed so he asked me to get the preferences of my PCP, Cardiologist & Surgeon. My dentist and I are friends besides the Dr/patient relationship, so he trusts me to give him the straight scoop.

Al - I read the "Dental Procedures and Warfarin" article on your website, but I came away slightly confused. I understood that I didn't have to do anything for simple cleanings or fillings, but I wasn't sure what to do in the case of a simple extraction (not oral surgery for wisdom teeth). That's why I posted the question.

 

[Herb M]

I have found that my dentist is more up-to-date than my physician on the use of anti-biotics as they relates to dental procedures for valve patients. He usually suggests that I check back with the physician on newer recommendations. The physician has always changed his recommendation after he checks further into what my dentist has said. I do not recall whether the dentist has ever advised me on my coumadin dosage before a procedure.

 

[Guest]

I usually advise against holding warfarin for a simple extraction. It is not a high risk for significant bleeding. You are at more risk from a clot than some minor bleeding.

 

[KristyW]

Thanks Al!

Thanks Al!

Thanks Al.

I thought that was what you were saying in the article, but I wasn't quite sure.

You are a great asset to us!!!