Teeth extraction when in AF and on Apixaban advice please

[Davidc1075]

Hi all. I suffer from Af and I am on Apixaban , I need several teeth removed due to an unrelated health condition. I understand the need to stop taking Apixaban 2 days before or what the dentist recommends. However I recall reading that there is an issue with the anaesthetic can someone let me know is there an alternative for those in AF and or on blood thinners. Ps does anyone have a dentist that either specializes in tooth removal for someone like me. Thanks in advance

[BobD Volunteer]

I have been on warfarin for more years than I can recall and my dentist has never wanted me to stop for any treatment. Be guided by your dentist. Never heard of a problem with anaesthetic, local or general.

[Bagrat]

I missed morning apixaban before extraction and as I did bleed a bit more than usual in the chair, dentist said restart next morning. It was an early appt so was going to take apixaban late. Dentist had said no need to stop.As to local anaesthetics, some people on here avoid local with adrenalin/ epinephrine as it can in some trigger an AF episode. It is this part of the injection that constricts blood vessels keeping the local close to the area. Without it , you may need a top up during a procedure. Good thing is the numb face wears off more quickly. Forgot to remind dentist last time and think I had one with adrenaline no problem. As it is impossible with the technique used to inject into a blood vessel, I don't think its an issue for most.

I'm sure I push out enough adrenalin of my own on a dental visit to make the jab fade into insignificance.

Dentists have book of instructions including medical conditions when adrenalin in local should not be used. AF is not on the list

[Hidden]

As Bagrat says, some members talk about asking for adrenaline free anaesthetics but when I had a wisdom tooth removed, my dentist said she didn’t use it because you needed a lot more to numb the gum. I found very difficult to get advice about Apixaban, the GP said ask the Dental Practice and they said ask the GP so in the end, again like Bagrat I missed a dose but the dentist performed the extraction said it wasn’t necessary to have missed the dose! Since then I have found the NICE guidelines, click on the link below and scroll down to the appropriate section headed dental and surgery advice.

cks.nice.org.uk/topics/anti...

Good lick………

[secondtry]

I had a large back tooth removed and requested adrenaline free anaesthetic, which worked fine.

[CDreamer]

I’ve had dental work done and had surgery and only ever stopped the Apixaban either the night before (surgery) or the morning of (dental work done in the afternoon).

You dentist should have a note of your medical history and be aware that anyone with AF should not be given a local anaesthetic containing adrenaline, as Bagrat outlined. I had the unfortunate experience of having a local with adrenaline early in my AF journey and was very ill. Luckily my dentist was very aware exactly why and took immediate and appropriate action. I was quite ill for a few days and couldn’t drive for a week.

Although not everyone reacts like that - I wouldn’t recommend trying as the consequences were not nice. I also have Autonomic Dysfunction so that was also probably a contributing factor.

[Bawdy in reply to CDreamer]

I had no idea adrenaline was used for extracting teeth, I had to have 5 teeth removed, in the chair, and while the dentist was giving me the injections my heart went crazy, I jumped in the chair wondering what on earth was happening. The dentist felt my pulse and said it was strong and the arythmias were playing up and it was happening because he had given me adrenaline . I had no idea this happened. I have to say it was a bad experience as I had two weeks of the worst pain ever. I am aware now and it won't happen again.

[CDreamer in reply to Bawdy]

Horrible experience, my sympathies. It’s amazing what we didn’t know, we didn’t know - especially about AF.

[Desanthony]

My dentist said I didn’t need to stop apixaban for my extensive dental work but I was wary and did not take my apixaban that morning at 8 the work was done at 2pm and no problems. I have not experienced excessive bleeding or extended bleeding in my 5 years on apixaban so now would go with my dentists recommendation and take as normal. Now got few teeth left for the dentist to play with🤣

[Davidc1075 in reply to Desanthony]

Any issues with the anesthetic?

[Desanthony in reply to Davidc1075]

No problems - adrenaline free.

[Buffafly]

I am booked for a surgical extraction and the dentist said there are a range of local anaesthetics and one without adrenaline was no problem. When I used to have the adrenaline one I used to have spasms of feeling ill for hours afterwards and finally collapsed with one so not knowingly had a dental injection with adrenaline since! No problem even with a root canal. I suspect as CD says that there are differing sensitivities.

[Bagrat in reply to Buffafly]

i had root canal and extractions with adrenaline free

[wilsond]

HiI gave had both root canal and tooth extraction,am on Apixaban and have aF and A Flutter.

I was put in first on list and told not to take morning dose of Apixaban on the day then take after proceedure. All ok.

The anaesthetic used is a non adrenaline based one. It's on my notes but always mention it as once I did that and he had nit noticed. He had the adrenaline one in his hand ..😲

No drama otherwise,af and Flutter behaved well!

I'm in Warwickshire and we have a good dental hospital in Ñuneaton.

Hope this helps.

[terryw]

Hi Davidc1075. It depends on whether you are a 'bleeder'! I appear to be. My first extraction resulted in two re-visits to the Dentist followed by two to A & E. before I stopped bleeding. I was better prepared for my second extraction, and had very helpful advice and contact from my Cardiology Consultant. I stopped my Apixban three doses before the extraction, and started it three doses after the extraction. I found Dentist and G.P. were conspicuous by their absence in giving Apixaban advice! Good luck. TerryW.

[Davidc1075]

Thanks all for your replies I asked my dentist who said speak to your gp. I did and they said it was up to the dentist so going round in circles. Think I will just stop before like a lot of others have and start again after the procedure. Thanks for the advice on the adeneline injections

[Snowgirl65]

I had to be off Xarelto (rivaroxaban) 3 days before tooth extraction for an implant. I mentioned I'd like anesthetic without epinephrine because of a-fib, but was told it wouldn't be possible for the procedure. As it turned out, there wasn't a problem, and I was back on Xarelto the next day.

[marcyh]

I had a tooth extraction while on apixiban and stayed on it. I bled half the night and I wished I'd skipped the morning of. The dentist said no though. Last week I had minor surgery on a toe and, on my own, I skipped that morning. My GP thought it had been a good idea.

marcyh

[Teresa156]

I had to have a procedure recently called an apisectomy which is an infection in a very old root canal which was under a back crown. The options I had were take out the tooth, or have the apisectomy, where they basically drill through the crown to the candid and take out all the old stuff, treat the infection and do a new root canal. It is a long procedure. I am paroxysmal and I had an adrenaline anaesthetic. I was told by the Edontist that the top teeth are not usually near blood vessels where they inject but most of the bottom teeth are which could be more of an issue with adrenaline. I am going to try and bear this in mind for the future and it might explain why some are ok with the adrenaline and some aren’t. She did add that they always use a specific amount anyway and I did get the impression, she hadn’t had any issues in the past. I think I’d always try and opt for the adrenaline free though on the bottom especially. Like others have said, the adrenaline one controls blood better, but it lasts for hours and hours 😳

Good luck,

Teresa