Coumadin and strokes

[Blanche]

Bonnie:
Any cardiologist, dentist, or medical person who tells you you must go off Coumadin for 3 days for dental work is putting you at unnecessary risk for a stroke. No ifs, ands, or buts. I don't think that your doctors or dentist or the cardiologist who PMd you are bad, dumb, crazy, or stupid. But, in fact, they are WRONG. And I defy anyone to provide scientific or research evidence to the contrary.

The people here care about you. You've read the posts, more than a dozen over the past year or so, from people who were in the sampe position you are in now. They refused to go off Coumadin. Many of them educated their doctors and dentists by providing copies of the research and scientific studies. Most of the dentists agreed and were glad to have the most current, scientific information. Some people did change doctors.

You asked our resident coumadin "guru"for advice and his response was counter to your doctors. Heed his advice. Read the American Dental Association Guidelines and send a copy to all of the medical people involved. I have many articles that I will gladly send you. Most, like "Stop the Nonsense Not the Anticoagulants: A Matter of Life and Death," written by three dentists, and published by the New York State Dental Association, contain statements like the following:

"There are no well documented cases of serious bleeding problems secondary to routine dental procedures in patients receiving therapeutic levels of oral anticoagulant Coumadin...There are, however a number of documented cases of serious thromboembolic complications, including DEATH, from stropping Coumadin therapy for dental procedures." "SCIENCE SAYS STOPPING THERAPEUTIC LEVELS OF COUMADIN FOR ROUTINE DENTAL PROCEDURES PRODUCES A LIFE-THREATENING RISK TO THE PATIENT." (New York State Dental Journal, Nov. 2002).

So, you asked, "Do you think mine would risk me having a stroke?" The dentists who wrote the article for the NYS Dental Association said it loud and clear....."a life-threatening risk to the patient." Sunshine Susan, in another post, said something really important. "At the end of day, we all have to follow our doctors orders or argue for change." Now you know the risks. If you want to share information that I have mentioned with your doctors and dentist, contact me. At least make a copy of the American Dental Associations on Al Lodwick's site, along with the information he has provided, for your dentist.

 

[Guest]

I had a doctor tell me once that he was afraid that a patient would bleed to death after getting a tooth pulled.

I asked him, "When you were in training did you ever take care of a gunshot patient who lived?"

He answered, "Yes."

Then I asked, "Do you really think that this person is going to lose more blood than that?"

No answer.

Another woman who came to my clinic was very upset with me because I recommended that she not go off warfarin for an extraction. She was mad because she was up all night holding a gauze pad on her socket. I asked her how she would feel toward me if she were not able to move her hand up to her mouth. I also asked her if that was worse than getting a new valve.

She decided to go to the rival clinic in town. Was I glad?

 

[Granbonny]

Thanks for your concerns

Thanks for your concerns

Ross. ...Mad at you never.. I love you like a son ....Blanche..I did a google search today..Coumadin ..Dental extractions...The first one that came up was the NYS...Dental Association. Read the entire article...but also read all the following ones...Space Coast Medical Assoiates in Fla......The Heart Surgery Forum...Wilford Hall Medical Center.Coumadin Clinic....more..but all the above said to hold your coumadin for a few days for MULTIPLE extractions..which I am having 2 pulled. Al..also read all yours..where you stated 2 days would be plenty. I have decided to hold Sat. a.m. 5mg and Sunday a.m. 2 1/2 mg. and Monday a.m.'s 5 mg. Appointment at 10 a.m.... Like choosing a valve. this is my personal choice and feel comfortable with it... My PCP also wants me to have a colon test done in the near future. So, this will be a trial run..in case Doctor Moore wants me to come off it.....I'm sure I will have a Happy story to post after my extractions for other's on the board..and not a scary one. Bonnie

 

[Granbonny]

Blanche

Blanche

In my first post..I asked for members who were on coumadin and had dental procedures. So far, none have responded..Did you say..at least a dozen? Is there anyway I can pull up their threads. Do you remember any of them..Would like to PM them and see if they had any complications staying on it...Bonnie

 

[Blanche]

Bonnie:
Will send a PM after this post. I read your first post on the thread "First Time" and thought you were asking Al Lodwick (You said, What do you think Al?). That's why I did not respend to your first post. Perhaps others thought that way too. I suggest that you begin a new post that is more specific. Maybe something like, "WANTED Members Experiences With Coumadin and Dental Work."
As far as dental procedures and anticoagulation, I don't recall anybody who went off Coumadin without Lovenox or heperin. Some of the people who have reported on staying on Coumadin were: Marty and Ross for root canals, and Shezagirlie for removal of a wisdom tooth. Both ccrawford and Sunshine Susan responded to you on this thread. I can't remember all of the people who discussed dental work and Coumadin but Kim, MarkU, Dick V, Al Capshaw, John and Joanie, and Gina come to mind. You might want to do a search of the board on Dental and Coumadin. You might also want to search colonoscopy and Coumadin. Again, if you would like any scientific, research based, or evidence-based dentistry articles, let me know.

I do agree that, in the end, it comes down to personal choice. For me, it's important to be informed and be completely aware of and willing to accept the risk involved. In the benchmark Wahl study I quoted before, of the 526 patients who experienced 575 interruptions of anticoagulant therapy, only 5 suffered serious complications. That's less than than one percent. However, four of those patients died.



Blanche

 

[Guest]

That is what this site is all about. You get the information and you make your choice based on what you believe is best for you. No study, no matter how well done, can account for your individual situation. I'd say case but have learned not to use that word.

After my first wife died and I remarried, my daughter who was in about 5th grade came home from school one day and was describing the home situation of a new classmate. She finished by saying, "Boy her case is way worse than ours." Well, my wife let her know in no uncertain terms that she was not going to have her marriage referred to as a case. Since then I have tried (sometimes more successfully than others) to not refer to people's lives as cases.

Your most fervent wish should always be than nobody ever utter the words "interesting case" in conjunction with your name.

 

[Gail in Ca]

Before my sternal wires were removed I stopped taking coumadin per surgeons orders 3 days before the surgery.
The morning of my surgery my inr was 1.6! No one seemed concerned over it, as a matter of fact the surgery wouldn't have been done had it not been a number they thought was okay.
Now that I ponder it, I'm sure it was risky, but I was following pre surgery orders.
I take alot of coumadin anyway and my liver seems to really process it. My inr took awhile to come back up, seems like I adjusted it for 2 weeks after the surgery to get it back to the range I like.
Gail

 

[Guest]

When you have to undergo a procedure such as removing the wires, you have to stop the warfarin. There is some additional risk that people who take warfarin have to accept in times like these.

I saw an older man (80-ish) yesterday who had his warfarin stopped for three weeks because he was going to have a circumcision. Now to me that is an unacceptable risk of stroke. I wonder how much responsibility the surgeon would have accepted if he had left the man in a vegetative state because he wanted to do this "life-saving" procedure on a man who was taking such a dangerous drug.

 

[John & Joann]

Update for several new members. Joann has 2 valves and has been on coumadin since 1971. She recently had her pacemaker changed and had her INR above 2 during the procedure. Most dental procedures can be done without coumadin withdrawal.

Joann had 1 major stroke when stiching on the original Starr Edwards valves failed and around 20 TIA'S following her valve replacements. They were a result of the scraping of the scar tissue during the repeat surgery.

We also know someone who had his coumadin withheld for a colonoscopy. He lived his last 7 years in a nursing home.

Joann is HIGH risk and keeps her coumadin between 2.5 to 3.5. She had a fall this spring and hit her head. We did NOT go to the emergency room. Cleveland Clinic discovered that she had a significant bruise. Always seek medical attention if you have an accident or fall.

It will be a cold day before we will agree to withdraw coumadin. It was withdrawn for 3 days before the valve replacements. Hopefully, that will be the last time that she is off coumadin.

We are looking forward to many more years of life, travel, and helping others.

GO BUCKEYES!

 

[Missy]

I am on Coumadin; had extractions

I am on Coumadin; had extractions

I am on Coumadin and I have had teeth pulled. My dentist withheld coumadin with my cardiologist's consent. But then my cardilogist has me take heparin injections or lovenox. For 6 days, three days before and 3 after to make sure my coumadin level was back up before I got off the shots. Iti is kind of a hassle but I had rather be safe than sorry. My insurance pays for it. ( Although deductible is going up so that may not be true in the future.)
I have read about the new thinking of not doing anything and it may be true, I just haven't researched enough to be comfortable with it.
I do trust Al on this though. He is usually right.
It seems like Gina had this experience. Contact her.
Good luck.
Missy

 

[Nan]

Hi,

I changed dentists when the one I was going to right after my AVR wanted me off Coumadin for anything! New one is fine so far with staying on for at least routine stuff.
When I had a colonoscopy, my cardio and pcp put me in the hospital on heparin while we d/c'd the coumadin, and then stopped it briefly before the procedure. Then 3 days to get the coumadin back up....but definitely safer.

 

[SHerrin Hutt]

STROKES

STROKES

HI Bonnie
I have had this problem more than once. With my history of strokes and blood clots, They take no chances they put me in the hosp. when my inr is 2.3 and but me on IV heperin till it is closer to the time of surgery. So this past year I went in for a reveal montor to be removed and abess tooth pulled and hand surgey I was in the hosp. longer for some of theses thing than for the heart surgery. Right now they are playing around with my meds. last week I was a 6.5 and this week they told not take any on thur and to take 4 mg. till mon. when I retested yesterday I was 1.6. I have been doing this since I had my surgery in 3/02. That why the insurance co. bought me the protime machine. I really get scared about the stroke issue because my grandmother had one when she was 18 and never walked again.
Sherrin Hutt
Mirti valve repair4/99
Mitri vaalve replacement 3/02