Got a dodgy wisdom tooth. My dentistgave me a choice to see "how it goes" or extraction. He said he wants me to stop my Apixaban 24 hrs before and 6 hours after. Im a bit worried about stopping Apixaban. What are the odds of me havinga stroke.. I am 70 yrs old.
Tooth extraction: Got a dodgy wisdom... - Atrial Fibrillati...
Tooth extraction
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gateman
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Not sure anyone can give you an answer.People frequently have to stop Apixaban or another anticog. before an operation so it is not unusual . I stopped for 48 hours before a hip replacement following an ancident but it was not stopped before a closure to a hole in my heart.
Hi,
In Nov 2015 ( age 71) I had knee replacement surgery and had to stop Warfarin 6 days before the op. No problems. It is/was significantly more challenging surgery than a tooth removal. After I was returned to my room I was given two doses of a bridging (fast acting) anticoagulant (Fragmin) and then in the evening I returned to my daily bog standard dose of Warfarin. Have to say that on balance my health is pretty good ( apart from AF, now highly controlled ) and these days in more current times - osteoarthritis in many joints. Of course I can't really comment further as I don't know your over all health status. Might be an idea to discuss this with your GP or Anticoagulant Clinic.
I'm on Warfarin and never had to stop for tooth extraction. Dentists usually pack well. However wisdom tooth might be a bit different.
I had to stop for a few days before hip replacement .
Recheck with your dentist and let him know your fears.
I don’t think anyone can give you the odds of you having a stroke, especially on this forum as we are not medically trained.
I had two extractions a few weeks ago, admittedly not a wisdom tooth, but I only missed my morning dose of dabigatran, then restarted with the evening dose. No problems with bleeding because the half life of both Apixaban and dabigatran is 12 hours.
You could speak to your GP, but no doubt you will be told that the decision has to be with the dentist doing the procedure.
How active is your AF at the moment?
I sympathise gateman - it's not something which can be answered, even by the most eminent cardiologist, it's a matter of one risk versus another risk.
My dentist asked me not to take Apixaban on the morning of extraction on Tuesday for a large, curved rooted lower tooth but to resume shortly afterward. I think it depends on the dentist's appraisal of the possible difficulty of the extraction and the need to limit bleeding.
Can’t advise but can provide you with a link to NICE guidelines. Scroll down to surgery and dental advice.
cks.nice.org.uk/topics/anti...
I had a wisdom tooth removed about four years ago and the dentist said ask the Arrhythmia Nurse and she told me to ask the dentist. In the end I missed the morning dose but took the evening one. It was out in a flash and with no excessive bleeding or drama…….
I had 2 extractions a short while ago. Dentist did not advise me to stop edoxaban but decided to miss my morning dose. I experienced very little bleeding. My view was that the risk of stroke over thev24 hours was extremely remote.
hi, I’m on Apixaban and am due a tooth extraction in 2 weeks. Dentist said no need to stop anticoagulant as he will plug it well if it bleeds.
If you were on Warfarin they have the mouthwash antidote if needed but nothing for Apixaban.
Wisdom teeth maybe a bigger extraction so think I’d ask the cardiologist what he thinks. They may want to do it at the hospital.
I am on Flecainide which I now take regularly ( 100mg twice daily) so no longer take an anticoagulant and had a premolar tooth extracted a few months ago with no ill effects. It’s healed very well as I don’t take anticoagulants but I decided not to have a replacement implanted as it doesn’t show and my tongue likes the gap! As long as you have suitable anaesthetic and keep calm, the dentist must know that you will be fine. After all, a lot of their training is like doctors have. Mine checked with me before doing my extraction and doesn’t seem to mind that I decided against the implant. Hope it goes well for you too and Happy Winter Solstice!
Not sure of the connection between taking flecanide and the cessation of Apixaban. Apixaban or other anticoagulants lower the risk of clot formation, whereas Flec works to regulate the heart beat.
If you were prescribed them before I'm curious as to why the Apixaban has been stopped now.
The risk of stroke is higher in AF patients and if you score over 1 on the system, it is recommended to take ACs. Even after ablation it is recommended to remain on AC for life.
I don't understand why you don't take an anticoagulant any more. I'm 78 and see my anticoagulant as a friend for life, reducing the chances of a stroke.
I am 79 but if I am not having any more episodes of AF, I am no longer at risk of stroke as a result!!! I’ve avoided the unpleasant side effects and I’m still alive!!
What happens if you go into AF without anticoagulant protection, IMO it's risky.
But I don’t and haven’t for about a year now! The EP who prescribed the Flecainide for me originally told me that unless an episode occurred with a very high heart rate for a long time (12 hours or so, which it never has done) I was not at risk of stroke! I took various anticoagulants at first, all with unpleasant side effects!
Once you've had AF, whether or not you have it again, your stroke risk is still elevated. As for side effects. I did get them from Rivaroxaban so changed to Warfarin. The only side effect of that is brittle fingernails, which isn't a problem.
And then you are not allowed to have lots of nice green vegetables and other things which are natural anticoagulants so no thank you! I used to be woken by any episodes I had during the night when I still had episodes and Flecainide taken as a PIP stopped them in a couple of hours!
Yes, ok but the Flecainide does not stop your blood from clotting. When you have AF the blood pools around the heart and forms clots as it gets blocked by the arrhythmia. Once you are diagnosed with AF you have it for life. It is treatable but not curable. You are taking a risk, but that is your choice. I would not want to spend, what life l have left, like a vegetable unable to move, eat or drink, after a stroke. You are playing Russian Roulette here. As far as l am concerned my anticoagulant is saving my life. Take care and Merry Christmas
Happy Winter Solstice! I’m 79, have never been overweight etc and don’t expect to live forever having already outlived both my parents!
Come on. In this day and age you are still a “spring chicken.” You may have many years left yet to enjoy. I am thankful my condition was diagnosed as lots of folks don’t know they have this monster and die of a stroke. I am a Christian so Christmas blessings to you and your family. Xxx
I have greens most days, and salads. I have a pescatarian diet. I have my own INR test meter and adjust my Warfarin dose if needed. No-one can undo a stroke.
You can have AF in your sleep and not know. The same goes for heart attack. My father had heart attack in his sleep and was not aware until he had his yearly check up. Anticoagulants are the most important treatment for heart conditions.
Say the drug companies! I’m 79 already and don’t expect to live for ever, having already outlived both my parents!
Exactly! Spot on! That’s what did for me! Or rather getting it and not being offered an antiviral! The fatigue has put an end to my active life but at least my brain still functions!
Of course the risks of stroke associated with "the company AF keeps" will still exist, but from your replies I sense you don't have issues with comorbidities?
Positively though, you have lowered your risks of "major bleeding", as you no doubt already know.
I support you and your informed choice in this matter.
Hi Vonnegut,
I fully support your decision not to take an anticoagulant. I am a 77 y.o. man in Sacramento, diagnosed with a few hours-long episodes of AF about two years ago. Shortly after diagnosis, I began 50 mg Flecainide twice per day plus 25 mg metoprolol once/day and, until recently, no more significant episodes of AF. I am fit and active with no other problems. Over those two years, I felt maybe half a dozen AF runs that lasted less than half a minute. I am certain that I can feel any palpitation and know when it is AFib, and I know, too, that it would definitely awaken me from sleep. With such a low AF burden, I happily choose to avoid taking yet another drug, an anticoagulant.
However, as expected with this treatable but incurable atrial fibrillation, a few weeks ago I did have a sudden and unexpected AF episode that returned to normal sinus rhythm in exactly two hours. I now understand that if I had taken an extra 100 mg Flecainide at the time of onset, the duration might have been shorter, but who knows? With estimates that range from >5 minutes to 2 hours to 12 hours to 48 hours, nobody seems to say for sure how long in AFib before clotting becomes a significant risk, but I suspect the overall health of the individual plays a major role in the degree of that risk.
Anyhow, that 2-hour episode alerted me to reconsider an anticoagulant, but my cardiologist suggested if I have more longer breakthrough episodes to raise the Flecainide dose to 100mg twice per day. So far, no sign of recurrence, so I stay at 50mg. However, to add to my defenses, I did fill a prescription of Pradaxa (dabigatran) which I will be willing to begin taking if and when I have an AF episode lasting longer than a few minutes. I had a long talk with the pharmacist who agreed that taking a capsule in that sort of pill-in-pocket way would be effective for anticoagulation. If I were to do that, I would likely stick with taking the anticoagulant indefinitely, but there are some assertions out there needing more study that suggest stopping after 30 days if no more AF episodes might be a reasonable way to reduce lifelong risk of complications from anticoagulants while still “thinning blood” during and after occasional AFib events.
Hi
First I am 74 and had operation 2020 with uncontrolled AF H/R raid Ca Thyroidectomy after stroke showing AF rapid and persistent, last year 2022 TVT partial removal J&J raggered mesh, and October 2023 Right Shoulder Repair.
All no problems.
All stopped PRADAXA 150mg x twice and then 110mg x twice 3 clear days pre operations and 2-3 days after.
My stroke was embolic so AF caused a rogue clot which lodged in my left frontal brain lobe at 2am Sept 2019.
You do sign off for risks. The first 2 operations I had 2 anaesthetists in public hospital. The 2nd and 3rd operations the introduction to CCB AM and BB PM meant my H/Rate Day dropped to 88-96 H/R. Then a year later dropped again to 60s Day H/R avge showed on latest ECHO and ECG.
There is a slight risk but the anti-co.agulant stays in your blood stream pre but dentist knows when you are settled after it only a little time needed and I had General Anaesthetic.
I had 2 upper Wisdom out, 1 was ingrowing and other rotten. Then they said no good to me anyway. 2 bottom wisdom teeth never appeared.
My personal choice would be get it out. An infected tooth is 'hell'.
Go for it and I am sure there is more risk in 2 hour operations with General anaesthetic than injections.
In March this year I had an infected tooth out. I was asked not to stop it so I delayed by 3.1/2 hours. Then another tooth out not infected but past being filled again, then I asked and the dentist said no stopping. In September 10 days prior to
I think the wisdom tooth is deeper.
If you have AF check he/she uses the correct pain injections.
I was done both times at hospital because top teeth at the back are close to my sinus cavity. My Dentist declined to extract for this reason.
I hope this helps. I'm using past experience. I understand Wisdom teeth are nuisances.
You can check with your cardiologist./Dr.
cheri JOY. 74. (NZ)
I’ve had extraction and stopped my xarelto. I’ve also had cortisone shots in my back and had to stop for that. All went fine each time. I suggest having a discussion about the novocaine. Sometimes they add epinephrine, which doesn’t always mix well with afib. Good luck! 🦷
My EP told me to stop the night before, my dentist then told me I needn't have stopped! Chatting to my pharmacist about it later, he advised that Apixaban stays in your system a lot longer than people think, so I was glad I'd followed the EP's instruction as I bled for some time after as it was.
I had dental implants with extractions. Stopped apixaban for 2 doses and I was fine. After that some gum surgery was required but I forgot to stop the apixaban and there was significantly more bleeding. From my aspect I thought stopping one/two doses was the right thing to do. Obviously I don’t know the risk of stroke for that but it was right for me
Jane
Hi gateman this is a bit ironic as I had to have a tooth extraction last week. Well actually I was scheduled to have 2 back molars removed, now I’m on warfarin for a mechanical aortic valve replacement 6 years ago. Because these were the first dental extractions I’ve needed since my heart op my Dentist elected to not take both out at the same time at the last minuet, but after checking current policy and my having my INR checked prior to the procedure I didn’t need to stop my warfarin but his reasoning for not doing both at once was since they were both on the same side but one on the upper jaw and one on the lower jaw he didn’t want to risk having to cope the first potentially bleeding whilst trying to take out the second. As it transpired there was no problems and there was actually very little bleeding as he packed the extraction sight and got me to apply pressure for about 10 minuets. Now wisdom teeth are slightly different as they are often more difficult to extract as I understand and your anticoagulant is different to warfarin so the guidelines are probably different but if you’re concerned contact your GP for their advice, which is what I did.
I am 76 and at times have not taken my Apixaban purely to see if there were any side affects and I do so often still here to tell you!
What side effects were you expecting? The main side effect of stopping Apixaban for a period of time (say, a week or more) is likely to be a stroke - and you really don't want that! I'm not a medic but, as I understand it, it can take time for a clot to form - so stoppping for a day or two doesn't increase your risk significantly - but who knows?
My answer was to show that not taking for a day in my case worked out ok, dental work can only be done minus meds such as Apixaban so to get dental treatment that is your choice!
l take Edoxaban - told my dentist prior to upper wisdom tooth extraction - she said no need to stop - extraction took 45 minutes to manoeuvre out - no probs 🤪
I was told not to stop my apixaban before my tooth was extracted by both my dentist and GP....... big mistake I bled for 12 hours as clot would not form, it was awful. If I ever have another removed I would definitely stop the apixaban.
I had two wisdom removed recently. On 10mg Apixiban daily. Did not stop taking them and had very limited bleed. Each to
His own but I would not stop the med. Steve
I had to stop my anticlog 24 hours before my ablations.
I had a wisdom tooth taken out earlier this year. Stopped my Apixaban for 48 hrs. Gum stitched and packed. No issues whatever considering the roots were very tangled. HTH.
I had 2 teeth removed a few weeks ago dentist advised to stop preceding night time and morning dose of Apixaban. Very little bleeding after teeth extractions but constant oozing of blood after local anaesthetic wore off. Returned to dentist 2 hours later and had more stitches put in. Eventually stopped oozing small amount of blood after 10 hours! I was getting worried. Dentist commented himself and colleagues have noticed extractions when on the new anticoagulants do seem to ooze blood more than when on no anticoagulants but on the plus side the wounds themselves seem to heal better. No research as yet to back this up.
I was instructed to stop my anti coagulant 3 days prior to my mini maze surgery which included my LAA being isolated with atriclip. I don’t take the anti coagulant anymore but stopping three days prior was no problem.
I had a wisdom tooth out and on apixiban. My dentist didn't mind me on apixiban and just said it's fine as bleeding is minimal anyhow. Just keep an eye on it and if any issues give them a call.
I have had to stop Eliquis for a short time prior to dental procedures twice and both times the dentist required clearance from my cardiologist before he would proceed. Never caused me a problem.
hi, also ask about anti biotics as tooth infections/extractions bacteria bad for heart and adrenlin free anasthetic.
Glad you could remember the word adrenalin! For the life of me when I was writing my reply I couldn't remember the darned word. Christmas is driving me around the bend this year - Bah Humbug!
I just had a wisdom tooth pulled out this week. I’m on apixaban. The dentist put a stitch explaining it helps to keep the clot there. It was very sore when the freezing went out, but acetaminophen helped quite well. This is my third day, still don’t bite on that side. Have a pretty good bruise on my chin bone. So I don’t think it’s always necessary to stop taking thinners before dental work, I never have!
Did have a mild stroke when not with apixaban and was taking something natural, which didn’t obviously work!
I HAD to have a molar removed 18montbs ago because the dentist didn’t treat it soon enough 😡 I’m on Apixaban and she had no idea how to treat someone on it without looking on line!! Said don’t take it the morning of treatment and that was it! Well I was ok, no AF, bit traumatised as I HATE dentists and sore for couple wks
We often have to stop the apixaban for anything up to a week before operations or procedures. My longest was 3 days for my total knee replacement. I didn't have a stroke and I was 76 at that time and had not been able to keep fit as I normally do for a long time due to my knee. I have only once stopped my apixaban for tooth work and the dentist did say I didn't need to but I felt better coming off at that time. Now I am happy to do as they suggest. You should also ensure that your dentist uses the correct sort of anaesthetic as some can cause problems for people with AF - though your dentist probably knows this and does so but always best to check. I can't remember the name of the stuff in the anaesthetic injection now - hopefully someone will come along who can tell you.
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