visit to dentiste / some advise please

[karim123]

can i stop Rivaroxaban or not please need one teeth taking out / thax / hop you are ll ok thx

[PeterWh]

Check NICE guidelines for NOACs. Personally I believe no.

Certainly for Warfarin the guidelines were changed so that it is NOT stopped at all for almost all dentistry work (certain things done in a hospital may require it to be stopped). Also INR can be up to 4.0 so that gives you a clue as to how low risk it is (most people's range is 2.0 to 3.0).

Many dentists are unaware of the changed guidelines.

Also ensure you ask for adrenaline free injections.

[Finvola]

I take Apixaban and my dentist was happy to take out a large tooth without my having to stop it. He observed the socket for about 15 minutes and when all looked OK he packed it with dissolving gauze and put in 2 stitches. I had my extraction at 8.15 in the morning and took my morning dose afterwards.

Take Peter's advice and also talk to your dentist beforehand about your needs - adrenaline free injections and Rivaroxaban.

Best wishes

[karim123 in reply to Finvola]

thankyou

[PeterWh]

I should have included that if the dentist refuses ask another in the practice or ask about cross referral to another practice.

I was told that stopping anticoagulation and then restarting has a greater (over double) risk of someone in AF who has not had anticoagulation.

[karim123 in reply to PeterWh]

thankyou

[Hidden]

You should inform your dentist that you are taking anticoagulants. Many dentists now have procedures in place to enable you to continue taking them. We would also suggest that you request an adrenaline free anaesthetic.

[karim123 in reply to Hidden]

thankyou

[sapphy]

Hi Karim, I take one of the new NOACs, Dabigatran in my case. I have been referred to the dental hospital to have it removed as the dentist felt it the best place to do it. I had one out a few years ago and was advised not to stop taking it and they used something they described as similar to seaweed to stop the bleeding. Make sure you ask for Adrenaline free injections. good luck

[karim123]

thankyou so much

[Eliza2]

Gosh, my cardiologist and EP both told me to stop my anticoagulant for at least 3 doses (take them 2x a day) before my oral surgery. Also neither were very concerned about the tiny amount of epinephrine used in numbing as the epinephrine only stays localized in your mouth as long as your dentist doesn't inject it into a vein! Having the tiny amount helps the bleeding stop sooner and reduces the pain. Research shows that the amount of epinephrine your body produces when under stress such as going to the dentist is far greater than the amount used in the numbing which is extremely little and the research concluded having the epinephrine vs not shows no difference in the reaction. The racing heart is more due to the stress in the body. If I knew the article I would list it but cannot recall believe it was from university in the states. I'll try and find it.

[karim123 in reply to Eliza2]

THANKYOU

[Eliza2]

2000 journal of the California dental association article on epinephrine used during during dentistry is the article I was talking about in previous post about this topic. There are others but that's the one I just found.

[PeterWh in reply to Eliza2]

I think that is out of date now - realistically 17 or 18 years ago.

Certainly in the UK the guidelines are clear do NOT STOP anticoagulation. Obviously the US has different rules.

[karim123 in reply to PeterWh]

thankyou

[Eliza2]

I know that's an old one but there obviously are two different schools of thought on these issues. As with almost everything......a bit disconcerting though that the specialists are recommending something so different! My EP is world reknown and was emphatic on both counts........

[PeterWh in reply to Eliza2]

Just because he is well renown does not mean that he is infallible npor that others may have different views.

The original view was that you had to stop but that view was challenged, tests done (which showed no ill effects and benefits) and new advice put in place.

If you think about it logically the amount of blood coming from dental work is so small how could it cause a major problem? What about cutting yourself with a knife? That could easily produce far more blood. If it was that risky all Warfarin users would have had to have been wrapped up in cotton wool 24/7 to protect themselves!!!

[Eliza2 in reply to PeterWh]

Seems like a pretty important issue though for him to not know ......my cardiologist also said to go off for 3 doses. This isn't about being infallible. It's about a difference in opinion which I'm sure is backed up by plenty of research. Doctors disagree........who is to say who is "wrong".

[Perrylees]

I think there is a definite school of thought now that stopping a NOAC for a short period of time can cause more problems than it solves. Its a different thing altogether of course but I had a small pulmonary embolism after my ablation and my EP is certain that this was caused by me missing one dose of apixaban.... there is some research that suggests that blood becomes slightly more clotty (I think that's the technical term!) when a dose is missed?? He has told me that in future he will never advise patients to stop apixaban prior to ablation.

To get back to the point I have had a large piece of broken tooth removed and a large filling (in said cavity) in the last fortnight. I didn't stop the apixaban and although I think there was more oozing (another technical term but this is what my dentist said!) than he would really have liked, the bleeding stopped after a few minutes and I have had no issues whatsoever since. He was completely unconcerned about the whole thing too. By which I mean he is well up to date with NOACs and was confident in what he was doing. I had an anaesthetic injection - I have no idea whether it contained adrenaline or not - didn't know about that but again no issues at all!

Ruth

[karim123 in reply to Perrylees]

thankyou

[PeterWh in reply to Perrylees]

Ruth. I don't know which hospital you are under but the view / practice of a number of leading EPs is just that.

I was on warfarin and when I had my catheter ablation my warfarin was NOT stopped either the evening before nor on the day itself. What's more telling is that EP wanted my INR in the range 2.5 to 3.5. Those points tell a whole story. A catheter ablation is far riskier in terms of bleeding than thousands of other operations / procedures!!!!

I also had to have a lumbar puncture recently and they gave vitamin k and stopped warfarin for 4 days. Heart consultant at heart hospital said that they would have not done it that way and definitely should as a minimum had bridging by clexane or other.

[Perrylees]

Hi Peter - I'm at Wythenshawe in Manchester or if I'm lucky the Alexandra where my EP also does some private work. I was one of his first ablations with apixaban and he was very candid about how there is a still a steep learning curve in the use of NOACS. I can't say it's particularly reassuring being a Guinea Pig but I guess somebody has to be it!!

Ruth