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  • Does this sound right?

    Hi Everyone!
    I have been waiting to hear from my doctor about what he wants me to do with my coumadin before my dentist appt. This is what he finally told me to do....

    Cleanings: Stop coumadin the day before dentist appt. After the appt., start your coumadin again, that day.

    Procedures: Stop coumadin three days before appt. and start taking coumadin again after the appt, that same day.

    Does this sound right? I know some of you have written that you keep taking your coumadin like you always do, before a dental cleaning. The doctor keeps my INR between 2.0 and 3.0.

    Thanks & Take Care!
    God Bless!
    Ascending Aortic Dissection & Anuerysm Repair 9/2002
    AVR 9/2002 (age 34 when diagnosed and had surgery)
    Dr. Svennson (Cleveland Clinic Foundation)
    My DOB is 08/01/1968

  • #2
    Hi silly person!

    Continue the Coumadin for simple cleanings. Don't stop for this alone. I've had mine cleaned, drilled, filled, and scaled while on normal coumadin therapy and there has not been any troubles at all. I think your Doc is wrong and you should print out and take the page from Al's site with you. I'm going to Al's site and get you the link for his dental procedures page. ;) The only time you may need to come off the Coumadin is with mulitple teeth extraction or oral surgery. Check the link out below, it's updated!
    Last edited by Ross; January 6th, 2003, 01:38 PM.


    • #3
      Hi Gail,

      You really need to read the recent update that Al Lodwick did to his website and the related thread in this section, discussing the risks of discontinuing Coumadin therapy for dental procedures.

      I for one would be very hesitant to discontinue my Coumadin for any routine dental work. The risk of having a stroke is too scary to me.

      From the layman's knowledge I have of how Coumadin is processed by the body, I wouldn't think that discontinuing for one day prior to any procedure would have much effect anyway.

      "It doesn't get easier, you just get faster" - Greg LeMond

      Mark U in Sarasota. FL
      Congenital Bicuspid Aortic Valve
      27mm St. Jude, 12-15-00


      • #4
        Yikes Gail. Listen to Ross!!! You were given incorrect info!

        The only time I stopped was when I had my wisdom's pulled. Back when bridging therapy with Lovenox was safe. I have read of others here lowering their INR's and safely carrying out extraction's too. Will have to look into that if that day ever darkens my door again
        All the best,
        LuvMyBirman :)
        MVR, 3/99


        • #5
          All dosage changes take 3 days to show a result so stopping a day before isn't going to change much of anything. I wouldn't risk it.


          • #6
            Hi Gail,

            So far all I've had is cleanings since my surgery. I stayed on my Coumadin. I took antibiotics, I believe it was an hour before the procedures. I wouldn't go off the Coumadin if I were you. Did your doctor give you a prescription for antibiotics to take?

            I believe others have had procedures done and stayed on their Coumadin too. You also should read what Al posted on January 3rd, 2003. "Risk of Stopping Warfarin for Procedures." Print it out and take it with you to your doctor and the dentist.

            I know others have had different procedures so I'm sure they can help you out with their opinion and experiences too. Hope I helped some. Take care.
            AVR & MVR and Tricuspid Repair
            St. Judes Mechanical
            March 8, 2001
            Chicago University Hospital


            • #7
              I was wlking around and cleaning up when I remembered to ask you if you were taking any antibiotics before the appointment. If not, you need to get ahold of the dentist and have him prescribe 2000mg of Amoxicillin or similiar, to be taken 1 hour before your appointment.

              Glad you jumped in Lorraine! I nearly forgot that part.


              • #8
                Yes, my doctor did write me a prescription for amoxicillin. I'm not sure what the dose is. I'll see when I pick it up. I will also be printing off a copy of Al's post. I did read it and that is why when my doctor gave me these instructions, it didn't sound right. I will definately print it and show it to him. My dentist will not give me an appointment until I do what my doctor tells me to do. If my doctor doesn't change his mind, my dentist will not see me if I decide to stay on the coumadin.

                Thanks Everyone!
                God Bless!
                Ascending Aortic Dissection & Anuerysm Repair 9/2002
                AVR 9/2002 (age 34 when diagnosed and had surgery)
                Dr. Svennson (Cleveland Clinic Foundation)
                My DOB is 08/01/1968


                • #9
                  Just continue the coumadin and don't tell him you took it. It's really too bad that these health care pro's don't have it together when it comes to us rat poison people. :D


                  • #10
                    I'm sorry you're stuck between the doctor and the dentist. The only answer is that patients must educate their doctors and dentists. Albert's been on coumadin for 12 years and had regular dental visits, including one extraction. Never had a problem and never went off coumadin. There is an article that you might tell your dentist about. It is, "Myths of Dental Surgery in Patients:Receiving Anticoagulant Therapy," M. J. Wahl, Journal of the American Dental Association, January 2000, vol 131, pp77-81.
                    Al Lodwick quotes this article. I could not find the entire article on the web, but there is an abstract. If you email me through this board, I can email it back to you. The conclusions this study, which involved 950 patients and 2400 surgical patients was
                    "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 below or within therapeutic levels.) Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientif fact, but seems to be based on its own mythology." The study also talks about 526 patients who had 575 interruptions of continuous anticoagulation therapy. "Five suffered serious embolic complications; four of these patients died." You might also check an article from the New York State Dental Association, entitled "Stop the Nonsense Not the Anticoagulants: a Matter of Life and Death" dated November 2002. I hope this link works.

                    You might want to send these materials to both your doctor and your dentist. Most state dental associations have position papers about interrupting anticoagulation therapy. Your dentist should know of these. I have a feeling that if you present him with articles from his professional peers that he will insist that you continue your Coumadin. To do otherwise in the face of research evidence is clear malpractice.

                    I wish I could do better for you, but I am not computer savy and am so limited. If you wish, I'll gladly send you the articles above and others that I have. Gail, you have such a positive attitude that I know you will make this work for you. OOPS! I almost forgot, you might also want to use Al Lodwick's newest materials on stopping anticoagulation.
                    Best wishes,


                    • #11
                      Hi Gail, I've had a crown replaced while on Coumadin with no difficulty. My dentist has a standing prescription for the 2000 mg of Amoxicillin and I take it one hour before my appointments.

                      As an aside, I carry this card from the American Heart Association on the suggestion of my cardiologist (it's about the antibiotics, but not the Coumadin):

                      Wallet Card

                      The relevant portion for valvers is about halfway down: "Prophylactic regimens for Dental, Oral, Respiratory Tract, or Esophogeal Procedures."
                      Last edited by Johnny Stephens; January 6th, 2003, 06:25 PM.
                      25 mm Aortic & 29 mm Mitral St. Jude Master Series Mechanicals - UWMC 4/16/2002
                      Guidant Insignia Pacemaker - Virginia Mason Medical Center 5/19/2005
                      Cardioversion Tote Board: 3


                      • #12
                        My Jerry had every tooth in his head crowned about 2 years before his AVR. Adjustments are still being made in his bite, etc., as well as some grinding, etc. and nothing has ever been said about coumadin. They do insist on him having the handful of pills 1 hr. before every app't though. He also had a checkup and
                        cleaning by his regular dentist since the AVR. Same deal. Oddly enough, I had rheumatic fever as a small child and about 15 years ago someone discovered that fact on a chart and now I have to take antibiotics every time before seeing the dentist.

                        I do have a question I'm going to post on another thread about a colonoscopy & coumadin. I read something a while back on here about it but wasn't concerned at the time.
                        Celia, wife of Jerry (the patient)
                        AVR 2/12/02, St Jude's Mechanical
                        1 bypass
                        Pericardial Window 4/22/02
                        Cox Medical Center, Springfield MO


                        • #13
                          Celia, you may want to inquire about a "Virtual Colonoscopy".
                          Check this link out!
                          Last edited by Ross; January 6th, 2003, 08:29 PM.


                          • #14
                            Never went off Coumadin except once for an extraction.
                            There is no reason you should stop it for what your'e having done.
                            AVR 7-29-96
                            St. Jude Mechanical
                            Wm. Beaumont Hospital
                            Royal Oak,Mi.
                            Dr. Paul Clancy

                            "Life is not measured by the number of breaths we take, but by the moments that take our breath away"
                            Geo. Carlin


                            • #15
                              Any dentist who stops warfarin for a cleaning may as well plan to go to court naked, because that is about how much defense they will have if something happens to you.

                              There is even research now that almost anything can be done if the INR is less than 4.1