On Warfarin and had wisdom tooth removed!

[Wightbaby]

Had a top wisdom tooth removed today, without prior notice! Dentist did not seem unduly worried about Warfarin and it bled very little on removal. However, had a problem with bleeding this pm and had to go back. He has stitched it, and said don't take Warfarin tonight. I usually take 5mg a day, and am worried about missing it altogether.

My last INR in February was 2.7 and luckily am due for a test tomorrow (Thursday).

Anyone else been in this situation?.....I so wish I had refused to have it out until INR levels checked.......(they could be anything by now).....although are usually fairly stable and very rarely go out of range. I am in PAF and also on Metoprolol.

[Wightbaby]

Update......30 minutes later.

Just had phone call from the dentist, who said he had checked things out with NHS England and to take Warfarin dose as normal, esp as I am having a check tomorrow.

More worried about blood clots than bleeding, so happy with that!

[Hidden in reply to Wightbaby]

Seems strange that the dentist didn't ask for a recent INR fig. One advantage to having a Coaguchek kit.......you can keep check at all times.

Hope you are recovered now.

Regards

Sandra

[Sue1955]

Hi sounds horrible I would make sure your anticoagulant nurses know by putting all details on back of your form. Or ring and talk to them. Don't think much to your dentist as as far as I am aware they have to have updated INR result before they can do anything. Hope all goes well any probs or worries contact coag nurses. They are the experts good luck x

[Wightbaby in reply to Sue1955]

Unfortunately we aten't lucky enough to have coag nurses as such, just a general nurse at the GP surgery, and to be honest, with the info I have gleaned from this site, I think i have more knowledge than them?!

[sirey]

I am due to have a wisdom tooth out next month at a local hospital. I've been told to continue warfarin as normal. Evidently providing my most recent INR is within range and tested the week before it will be ok to go ahead. I have been warned that I will have at least two stitches. Hope all goes well.

[jeanjeannie50]

I had a wisdom tooth out a few years ago. I was amazed how quickly my dentist extracted the tooth without me feeling a thing. For the rest of the day the area seeped a small amount of blood and before they closed I went back to my dentist who gave me some more pads to bite on. It soon stopped.

My dentists wife has AF so he understands the condition completely. In fact she's now his dental nurse (although a qualified (German) dental surgeon herself). I'm having a back tooth out next week and if it goes as well as last time I'll never worry about having teeth extracted again. By the way, he always asks what my INR is and the medication that I'm on.

Jean

[Wightbaby in reply to jeanjeannie50]

That was how it was! Out in no time.......!

But started bleeding profusely in the pm.....Trouble is because it was right at the back, there was nothing to bite down onto to exert pressure. However, it's been fine since the stitch etc., and not bled at all...More sore than painful today.....

[ILowe]

I think you will find that provided the INR is less than 4.0 they can operate. I had a big one done in outpatients a few years ago and the INR was 3.5, done 30 minutes before surgery. Each root had joined to the jaw and he had to slit the gum on the outside, away from my tongue, then he had to cut out each root. Stitched me up. No bleeding at all.

The down side is that no bleeding meant the normal clot formation -- the plug that forms in the hole and covers the jaw -- was not allowed to form. That meant agony for two weeks, but it did stop.

[Bagrat in reply to ILowe]

Our dentist will do extractions as long as INR less than 4 but she does like a recent test ( within 48 hours)

[Wightbaby]

INR's were 3.3 this morning. I guess they may account for the time it took to finally stop bleeding...not bled at all since the stitch though......

Of course the computer is now wanting me back to retest after 7days....how i WISH they would let me self test!!!

[ILowe in reply to Wightbaby]

If you pay for it yourself you can self-test. You do not need a prescription for the machine or the strips though I once lost an argument with a pharmacist on that one. The saved time is worth the expense.

[Wightbaby in reply to ILowe]

Hmm......my GP said we don't support it over here (meaning the Isle of Wight)........so are you saying I can just go and buy a machine myself, like you would buy a B/P monitor or whatever?

Where do you get from? Sorry I know that sounds really stupid!!!

[ILowe]

There are several monitors on the market. The one most people use is the Coaguchek machine. Buy it direct, and buy test strips and lancets. shop.coaguchek.com/?currenc... The machine costs 299 pounds ex VAT and you are eligible for this if you are on long term Warfarin. The strips do NOT need keeping in the fridge, but do have an expiry date so be careful -- the machine will not work with old strips.

[Wightbaby in reply to ILowe]

Thanks for the info....I will seriously consider this......

Will I need some sort of training as to how to use it.....I mean I watch the nurse and it looks very simple......but linking it with my laptop etc???

[ILowe in reply to Wightbaby]

There are videos to explain. The helpline is extremely helpful. It is only slightly more difficult than doing a glucose test. The machine saves your readings, but you usually write them down in your orange book.

Then there is the question of self-dosing or not. Some people phone the results to their health professional. Others do so only when they get stuck ie are out of range. Others handle it totally by themselves, with annual reviews.

[KipperJohn]

Hi WB as you know I'm on apixaban but it's basically the same issue. I had a troublesome tooth out at St Mary's about 6 weeks ago and a prostate biopsy within a week. There were differing criteria for how long I should stay off apixaban - a matter of a couple of days. Both procedures went ok but after a week I had a major bleed from the gum and went back for more stitches and a special mouthwash. The dentist was excellent and with careful management I had no more problems.

Sorry have not replied yet to your PM - have just arrived in Melbourne but will get round to it!

Xx

[ILowe in reply to KipperJohn]

You went back for more stitches. Exactly. That is why it is considered safe nowadays NOT to stop the anticoagulant. Any bleeding is obvious, accessible, looks worse than it is, and can be fixed.

The first tooth I had out, they used the 'Heparin bridge' and I assure you the bleeding was bad when they restarted the heparin, and probably worse than leaving me on Warfarin. They had to take me back down to the operating room for cauterisation the next morning. It worked. The second time, the doctor had learned, I had it in outpatients, and no bleeding at all. Marvelous, except for the extra pain due to a lack of bleeding therefore a lack of natural clotting plug in the hole. !!

[couma]

don't worry about skipping a dose INR at 2.7 is fine since you are taking 5 mg.