Okay...Scared

[Blake777]

Hi everyone, haven't been on here since I told you I was having some teeth pulled and dentist and doctor wanted to take me off of my coumadin, until I hit INR 1.3. Well even had a second opinion dentist like someone here suggested and got the same results. It's been about a 1 1/2 months I guess since I posted last. Dentist had to make my partials and all so it took a while, meanwhile I have this loose tooth in my mouth that I try not to touch. So they said to stop 3 days prior, so I stopped Sunday night, which is going to throw me into 4 days instead of 3 because I take it at night time and Wednesday is the day of extractions. I am scared, I don't know what is going to happen with all of this. On top of that my INR has been in the last 10 days 1.6, 5.4, 1.6, 2.1, 1.6, 2.1....just a yoyo , don't know what the heck is going on with me.

Need some comfort knowing everything will be okay, but somehow I just don't see that happening.

 

[drivetopless]

Hi, Blake-
I'm not on coumadin (yet) so I can't help, but your note touched me and I just wanted to send you a little electronic hug and tell you everything is going to be okay! I'm sure the experienced folks here can offer some advise. Maybe make your diet a little more boring (i.e. eat the same thing every day until you're over this hurdle)?

 

[Blake777]

Thanks a lot Drivetopless, I started out eating wrong today, but will get back in the saddle. I find it so boring to eat healthy choice meals, I try to cook my own food sometimes but then I only end up making two meals, because my hubby is so stubborn about his meals. But have changed my diet to the better for the most part since I had surgery. I try to exercise and eat right most of the time, but have to get a little better at this. I am just freaking out I guess...just makes since to be scared after the doctors tell you to stay within a certain target and then tell you to drop everything they told you for three days, lol.

 

[Ross]

They should have you bridging with Lovenox. Leaving you totally unprotected is unacceptable.

 

[Blake777]

Correction those INR levels are a result of me testing every two to three days because it was up and down so much. So per my doctor or warfarin therapist I kept adjusting and retesting. But last INR yesterday was 2.1, I am sure it will drop now that I am off for the next three days. Will retest Wednesday right before I go to dentist.

 

[Ross]

Correction those INR levels are a result of me testing every two to three days because it was up and down so much. So per my doctor or warfarin therapist I kept adjusting and retesting. But last INR yesterday was 2.1, I am sure it will drop now that I am off for the next three days. Will retest Wednesday right before I go to dentist.

Never test more then 2 times a week. It takes 3 days for a dose to show in the test. If your testing that much and changing the dose all the time, that's what the problem is.

Take what you normally take and wait a full week to test. If your too high, reduce the overall dose by 10% and retest in another week. Vice Versa if your too low.

 

[Blake777]

Well I test every 7 days but when it is too high or too low he will have me adjust and take again in two days.

Yes I know being unprotected is unacceptable, but what is up with the doctor he says the same darn thing. I just hope the days past with any problems. I already feel bad but don't know why I'm feeling like this, probably stress.

 

[Ross]

Well I test every 7 days but when it is too high or too low he will have me adjust and take again in two days.

Yes I know being unprotected is unacceptable, but what is up with the doctor he says the same darn thing. I just hope the days past with any problems. I already feel bad but don't know why I'm feeling like this, probably stress.

Your going to have to grab the bull by the horns and do this yourself. If they keep doing this to you, your never going to be stable. I don't like to tell anyone to go against their doctors advice, but when they don't understand dosing, which yours apparently doesn't, then you may have to simply disregard what they tell you, do it the right way, become stable, then let them know what you did.

Stress yes, but I'd darn sure mention to the doctors that they are risking you having a stroke with little or no protection and that's not acceptable to you.

 

[Blake777]

Hi Ross, actually I did take the bull by the horns the other day was 5.4, I called but I had already decided to not take it for two days and then test again. I am kind of used to my INR and the levels and what I need to do to get it right. But for some reason it has been acting crazy, but maybe I had some false readings and that is what through me. So now I will just retest to make sure the reading is right before I adjust.

But as far as continuing the warfarin for the dental procedure, I am kind of scared both ways. They keep saying I could bleed to death and they you tell me to do otherwise, so I am like I don't know what to do, that's whey I am scared. So what if I keep taking it and then can't stop bleeding or should I just go down to a 2.0 and just tell them I am at 1.3?

 

[Blake777]

oops, I meant I was going to stop taking it for two days.

 

[Ross]

Hi Ross, actually I did take the bull by the horns the other day was 5.4, I called but I had already decided to not take it for two days and then test again. I am kind of used to my INR and the levels and what I need to do to get it right. But for some reason it has been acting crazy, but maybe I had some false readings and that is what through me. So now I will just retest to make sure the reading is right before I adjust.

But as far as continuing the warfarin for the dental procedure, I am kind of scared both ways. They keep saying I could bleed to death and they you tell me to do otherwise, so I am like I don't know what to do, that's whey I am scared. So what if I keep taking it and then can't stop bleeding or should I just go down to a 2.0 and just tell them I am at 1.3?

Well they shouldn't be stopping your anticoagulation in the first place, but trying to educate these numbskull's is another story. I guarantee you won't bleed to death. I've been there. My team of know it alls, didn't sew one socket up very well and I bled for close to 24 hours before their brilliance kicked in, and they decided to restitch the area. These darn doctors had better start learning. Copy this PDF and take it to them. Maybe they'll listen to someone from the ADA:
http://www.valvereplacement.org/forums/attachment.php?attachmentid=8432&d=1273873932

Conclusions. 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 within or
below therapeutic levels). Interrupting therapeutic
levels of continuous anticoagulation for dental
surgery is not based on scientific fact, but seems to
be based on its own mythology.

 

[Blake777]

Ross I know you know what you are talking about. I am going to print it out and take it to him and ask him to read it for me or I will start to look for another dentist. I only have one test strip left and unfortunately won't be getting any more delivered to my door until Thursday. So trying to save that one until Wednesday day of extraction to see where I'm at. I want to keep taking it, and I don't think there is a way for them to know if I did or not because he did ask for proof. Thanks again Ross.

 

[ALCapshaw2]

Apparently your Doctor has Never Heard of Bridging with Lovenox Injections Before and After Invasive Procedures.

GEEESH !

 

[Blake777]

Yes he has but they say they just do that for medical procedures. He is my heart surgeon's assistant, he monitors my INR for the coumadin study I am in.

 

[Ross]

Ross I know you know what you are talking about. I am going to print it out and take it to him and ask him to read it for me or I will start to look for another dentist. I only have one test strip left and unfortunately won't be getting any more delivered to my door until Thursday. So trying to save that one until Wednesday day of extraction to see where I'm at. I want to keep taking it, and I don't think there is a way for them to know if I did or not because he did ask for proof. Thanks again Ross.

Just don't worry yourself about it. You won't bleed to death and your right, they probably won't know the difference anyhow. Then you can surprise them and say, HA, I never stopped my Coumadin."

 

[ALCapshaw2]

Yes he has but they say they just do that for medical procedures. He is my heart surgeon's assistant, he monitors my INR for the coumadin study I am in.

This is B.S.
Since when is a Dental Procedure NOT a Medical Procedure?

Actually it does NOT matter what kind of procedure is going to be done.

The DANGER is that you could form a Clot if your INR is Too Low for Too Long.

Coumadin has a Half-Life of 2.5 days (per post by Marty, an M.D.)
Lovenox has a Half-Life of 2.5 HOURS (per post by Marty, M.D.)

When Coumadin is stopped for ANY procedure, it takes 2 or 3 days for INR to drop to 1
During this time, you can be protected by Lovenox or Heparin until 12 to 24 hours Before (and After)
whatever procedure you are having, thus minimizing your Unprotected Time.

What does your Doctor (and Dentist) NOT understand about this protocol?

 

[Ross]

This is B.S.
Since when is a Dental Procedure NOT a Medical Procedure?

Actually it does NOT matter what kind of procedure is going to be done.

The DANGER is that you could form a Clot if your INR is Too Low for Too Long.

Coumadin has a Half-Life of 2.5 days (per post by Marty, an M.D.)
Lovenox has a Half-Life of 2.5 HOURS (per post by Marty, M.D.)

When Coumadin is stopped for ANY procedure, it takes 2 or 3 days for INR to drop to 1
During this time, you can be protected by Lovenox or Heparin until 12 to 24 hours Before (and After)
whatever procedure you are having, thus minimizing your Unprotected Time.

What does your Doctor (and Dentist) NOT understand about this protocol?

50 years of anticoagulation and we have morons to this day!

 

[Ross]

Got to thinking, you'd benefit from Woodbutchers thread: http://www.valvereplacement.org/for...43-Tooth-extraction....&highlight=woodbutcher

It's DONE ! It was horrible too ! The dentist was so nervous that it made me even more nervous than I was already ! Bombarded me with questions like, have you had your inr tested, are you sure you want to do this, what exactly is wrong with your heart ?! Then just after he'd done the first numbing injection he expressed his fears about me not having antibiotic cover ! It's not prescribed or required anymore by dentists here in the UK. Freddies reminder had been playing on my mind so I'd taken a full dose of antibiotic an hour before my operation but not told him, he seemed more relaxed when I told him I'd taken it !
What a horrible experience, 20 minutes of wrenching later, out it came with it's long bloody roots, and guess what, it didn't bleed ! He said that a patient not taking Warfarin would bleed more than I did ?? I tell you what, it's all a load of hot air and there's far too much fear surrounding the use of Warfarin.
The numbing has worn off now and it's not hurting too much or bleeding at all... I even took my big old tooth out of the tray and put it in my pocket, I'll have a look at it later !

 

[dick0236]

This is B.S.
Since when is a Dental Procedure NOT a Medical Procedure?

Actually it does NOT matter what kind of procedure is going to be done.

The DANGER is that you could form a Clot if your INR is Too Low for Too Long.

What does your Doctor (and Dentist) NOT understand about this protocol?

I fully agree with Al, this is Bull S--t. I also read Ross's post regarding the May 2010 article in JADA, and FULLY AGREE. Strokes ARE FOREVER. Over the years, and after I had my own stroke, I have had a few extractions, periodontal disease treatement, root cannels, etc. I cannot remember a time when I would have gone off warfarin for more than one day, if at all......and I have NEVER had excessive bleeding....nor has any dentist or oral surgeon ever mentioned any problem.

 

[olefin]

Blake, I had a apicoectomy surgery (cut off the tooth's root tip) back in January. An old root canal had gone bad. The endodontis said I'd have to stop warfarin for 5 days before. I said no, I would lower INR to 2.5 but couldn't stop warfarin. He then said, ok. I never checked with my cardiologist for I felt he would say the same as my GP for he said I'd have to stop warfarin and switch to lovenox.

After surgery the endodontis said there was no more blood than someone not on warfarin. He took 3 stitches, had minor blood seep at the stitches for couple days... about the same for someone not on warfarin.

Right now I'm thinking that same tooth will have to be extracted. The local oral surgeon refuses to do the extraction while on warfarin without approval from my cardiologist. So don't know the outcome but I'd stand my ground!

Darn shame about how most of the medical people feel about warfarin.
I think the big reason, they have never taken it.