According to the literature, an INR of 2.0 appears to be a "magic" threshold below which the risk of thromboembolic events increases for mechanical valves. Suppose you refuse to go below INR = 2.0 for any sort of dental work, does this really put you into a life threatening bleeding situation? My intuition says: "No" .
Refusing INR < 2.0 for dental work?
- Thread starter Dustin
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G
Guest
Your intuition is right. You would not get blood transfused if you lsot less than two pints of blood. Think of spilling a quart of oil on the garage floor. Does your dentist honestly think that you will lose more than this amount of blood. If not why not have the procedure done while on warfarin. If the dentist thinks that you will, look for another dentist who has better technique. Ther is a blood bank where you can get more red cells but brain banks where you can get gray matter are more rare than hen's teeth.
jeffp
Well-known member
You'd probably be OK for the few days that you were below 2.0, but why risk the chance? So the dentist can work worry free that he'll save a few gauze pads? If you did have a stroke, it's probably purely co-incidental that he wanted your INR down a bit. These things never happen to his patients!
Yeah, right. It's our responsibility to be sure we get the safest management of our INR; if the doctor/dentist doesn't have the skill or experience, we can educate them, or walk. It shouldn't be like this, but it is. Like Al said, its our brains vs a bit of blood (maybe).
Yeah, right. It's our responsibility to be sure we get the safest management of our INR; if the doctor/dentist doesn't have the skill or experience, we can educate them, or walk. It shouldn't be like this, but it is. Like Al said, its our brains vs a bit of blood (maybe).
allodwick said:
Yes, this makes absolute sense. It is, indeed, very hard to believe that a minor bleeding of the gums would require a blood transfusion with INR = 2.0 or a even little higher than that. There is simply something wrong with the dental procedure if you would end up losing more than two pints of blood. Even in the unlikely event of bleeding severely, there is a blood bank. Suffering a stroke would require a brainbank, which we do not have at the moment, regrettably.
ALCapshaw2
Well-known member
Go to Al Lodwick's website www.warfarinfo.com
scroll down the list of topics until you find the one pertaining to dental procedures, read it, and then print a copy for your dentist.
Somewhere on this site, there is a list of recommended Dental procedures by an American Dental Association. Maybe it's included on Al's website (I haven't looked at it lately and don't remember
)
'AL Capshaw'
scroll down the list of topics until you find the one pertaining to dental procedures, read it, and then print a copy for your dentist.
Somewhere on this site, there is a list of recommended Dental procedures by an American Dental Association. Maybe it's included on Al's website (I haven't looked at it lately and don't remember
)'AL Capshaw'
G
Guest
My chart is a slight update of the ADA recommendations. I have their permission to reprint it as long as I do not charge for it.
Al is so right!
Al is so right!
When was the last time you saw someone life impacted for years by losing
a couple pts. of blood? Thousands( including myself ) have their everyday life
affected by a stroke caused by low INR. Take it from me, it is a pain in the butt to change Drs. who worry more about a bleed then a stroke- but then
having a stroke can change your whole life. You make the choice!
Al is so right!
When was the last time you saw someone life impacted for years by losing
a couple pts. of blood? Thousands( including myself ) have their everyday life
affected by a stroke caused by low INR. Take it from me, it is a pain in the butt to change Drs. who worry more about a bleed then a stroke- but then
having a stroke can change your whole life. You make the choice!
RCB said:
RCB,
I have no mechanical valve yet, but I would definitely go for a bleed. My intuition says that people should drop their INR to the lower bound of their therapeutic valve range for dental work. Hence, in case your prescribed range is 2.5 - 3.5 then you should see your dentist with INR = 2.5. With your experience, what would you advise?
Al is the expert here.
Al is the expert here.
He is better qualified to answer your question. Given that, I had my four
wisdom teeth pulled while on warfarin. I bite on gauze for 6 hours and didn't eat for a day(didn't feel like it). That was in '72 and 2001 had a colonscopy
on warfarin. That is my experience.
Al is the expert here.
He is better qualified to answer your question. Given that, I had my four
wisdom teeth pulled while on warfarin. I bite on gauze for 6 hours and didn't eat for a day(didn't feel like it). That was in '72 and 2001 had a colonscopy
on warfarin. That is my experience.
Dustin said:
G
geebee
Dustin,
I will not go to a dentist who requires me to lower my INR for dental work. There is topical medication they can use to stop bleeding. There is also a cauterizing tool they use if the medication does not work.
Over the past 25 years, I have had cleanings, crown fittings, veneers, numerous root canals and a bridge all done while fully anticoagulated. I have never had any bleeding that could not be stopped although it was occasionally a challenge.
My INR range is 3.0-4.0 but I usually keep it above 3.5.
I will not go to a dentist who requires me to lower my INR for dental work. There is topical medication they can use to stop bleeding. There is also a cauterizing tool they use if the medication does not work.
Over the past 25 years, I have had cleanings, crown fittings, veneers, numerous root canals and a bridge all done while fully anticoagulated. I have never had any bleeding that could not be stopped although it was occasionally a challenge.
My INR range is 3.0-4.0 but I usually keep it above 3.5.
geebee said:
This is comforting to hear, since horror stories go around saying an INR of well below 2.0 for any sort of dental work.Your experience shows that dangerous bridging need not be necessary at all. Of course, this need not be the case for mechanicals who have other complications.
