ET and Oral Surgery

[Smoothie2020]

I have to see an Oral Surgeon and I’m nervous about having a procedure. I’m going to contact my hematologist because I don’t know if I need to stop HU and aspirin, do I need to have platelets checked, basically what precautions if any do I need to take.

[hunter5582]

It would be best to get case-specific feedback from your care team. The standard recommendation is to discontinue aspirin 7 days before a procedure. My MPN care team recommends 3 days in my case. That is long enough to lower bleeding risk but not so long to be too risky for thrombosis or other symptoms. It has never been recommended to discontinue cytoreduction. The surgeon needs to know about the HU but it does not change anything since avoiding contact with blood is always done.

The oral surgeon is very unlikely to know anything about the medication protocol for MPN nor the increased risk for hemorrhage with ET. Your MPN care team can provide the best consultation to you and your surgeon regarding your specific needs.

Please let us know what you learn and how things go.

[Smoothie2020 in reply to hunter5582]

Thanks Hunter. Will definitely update.

[Lyndjs]

Hi Smoothie2020 ,

My dental surgeon would not do anything without a note from haematologist. My haematologist said it would be fine to have a tooth removed and I could stop Aspirin for 3 days, prior to procedure. The surgeon then decided it best to stitch the gum to reduce bleeding. All went well. No need to stop peginterferon.

Hope this helps. I'm in UK.

[Smoothie2020 in reply to Lyndjs]

Good to know! I will definitely discuss gum stitching with the surgeon. Thanks!

[Lyndjs in reply to Smoothie2020]

It was a dissolvable thread but lasted well over a week x

[Mieshie]

I needed a root canal. After this diagnosis I called hematology for guidance as I was as curious as oral surgeon who was somewhat familiar with ET and HU, and requested approval and under what circumstances. I was told to stop low dose aspirin 3 days in advance. Was no concern about HU due to nature of procedure and surgeon staff normal prevention garb. I did skip the HU AM dose the day of my appointment. Had no issues. Returned to normal doses that PM. Should note I did not ever experience clotting nor bleeding issues so had confidence my risk of an oral surgery issue was low. Please do check with your care team and hoping you will have same level of confidence I had. Good luck.

[Smoothie2020]

Thanks for your response. I have not had any clotting or bleeding issues either.

[dogsandhorses]

I have ET Jak2, and had a gum graft while on HU. I did stop the aspirin for 3 days prior on the advise of the Oral Surgeon. Had no problems. My oncologist at the time didn't seem to care if I had problems or not, and blew off my concerns about it. The Oral Surgeon was much better about advising than the Oncologist.

[Smoothie2020]

Oh wow! I’m hoping for the best so we’ll see.

[john0084]

i have pv and take aspirin and hydroxy. Just before Christmas I developed an abscess over a slightly broken tooth, dentist issued me with antibiotics with an early Jan appointment for tooth removal. On the day though dentist wouldn't remove without hematology giving the ok. My consultant has decided to give me a blood clotting test, I'm just waiting for the blood form in the post.

[BloodZero]

A few years back i had oral surgery to remove three wisdom teeth. The surgeon reasoned that the aspirin and hydroxy were for my benefit so he did not ask me to stop them. The result. The next 48 hours I would not spot bleeding. i ended up in emergency twice and then back in the dentist chair. I was catching blood in a bucket. Spent three days in hospital. Must of got re-stitched about 3 times also.So in the future, i will be atleast stopping the aspirin a week before regardless of what im told. This event was to traumatic. (There is more detail to the story but i couldn't be bothered typing it all out on this little phone).

At present my Haematologists classes me in the high risk category for blood clot or stroke.

[Smoothie2020 in reply to BloodZero]

Oh wow!! I have not spoken to the surgeon yet but the scheduler said they do not require stopping aspirin. I am waiting to hear back from my hematologist to see what he suggests. If he says do not stop then I will challenge him on his decision because I feel that I should stop. Thanks for sharing your story. I’m sorry that happened to you.

[wrench69]

I am scheduled for elbow surgery in two days. Initially, the orthopedic surgeon's office told me to stop all medications 1 week prior. I am currently on both aspirin and Plavix (the Plavix due to having a cardiac stent placed about two years ago). I queried my cardiologist about stopping both of these meds. She recommended stopping the Plavix but not the aspirin. The surgeon agreed with this. Each case is different. If you have any stents, it might be wise to double check with the doctor who placed the stent.

[Smoothie2020 in reply to wrench69]

Yes I am definitely checking with all doctors to be sure I am doing what’s best.