Blood Thinners

(Coumadin or Warfarin, Aspirin, Plavix)

 

IT IS TIME TO STOP INTERRUPTING COUMADIN THERAPY FOR DENTAL SURGERY.

Many patients today are taking medication that thins the blood or makes it less likely to clot and block an important artery in the heart, lungs or brain. Coumadin is a common medication that has been used for over a half century, prolonging the lives of thousands of people.  If you have been instructed by your physician to take this medication, you should continue it, and you can undergo most oral surgery without fear of excessive bleeding.  With a few local measures familiar to all oral surgeons, you will be able to have your procedure completed without risk. Be sure to inform our staff of your prescribed medications, particularly Coumadin.

Aspirin is a very safe and effective drug that many people take daily to decrease the risk of heart attacks. This treatment can be continued right through your oral procedure.  Another commonly prescribed medication is Plavix. It can also be taken without fear of excessive bleeding following oral surgery. Physicians are referred to an excellent review in the Archives of Internal Medicine/Vol 158, Aug. 10/24, 1998, entitled “Dental Surgery in Anticoagulated Patients” by Michael J. Wahl, D.D.S. A summary of the article and our personal experience regarding this subject is included below. Unfortunately, there are several documented cases of serious embolic complications in patients when Coumadin therapy has been withdrawn for dental treatment.

“There are virtually no cases of oral bleeding that could not be controlled by local measures, even at PT or INR levels well above the therapeutic range.”

One reported case of bleeding was associated with Erythromycin and one with Amoxicillin used as premedication (see the new guidelines for premedication), but continued beyond the American Heart Association's recommendations. Even extensive oral surgical procedures such as full mouth extraction, alveoplasty, or the placement of dental implants can be accomplished with the patient in a therapeutic range.

Guided by the American College of Chest Physicians and the American Heart Association, we have found patients to do well without any serious bleeding in the recommended therapeutic range of the International Normalized Ratio (INR) of 2.0 to 3.0 for all conditions except for mechanical heart valves, for which an INR of 2.5 to 3.5 is recommended.

Smoking cigarettes seems to be associated with almost all postoperative complications, including bleeding, slow healing, and even the loss of otherwise highly successful dental implants.

These articles are the property of Musser & Richards, LLC, and may not be reprinted without prior permission.

Blood Thinners

(Coumadin or Warfarin, Aspirin, Plavix)

 

IT IS TIME TO STOP INTERRUPTING COUMADIN THERAPY FOR DENTAL SURGERY.

Many patients today are taking medication that thins the blood or makes it less likely to clot and block an important artery in the heart, lungs or brain. Coumadin is a common medication that has been used for over a half century, prolonging the lives of thousands of people.  If you have been instructed by your physician to take this medication, you should continue it, and you can undergo most oral surgery without fear of excessive bleeding.  With a few local measures familiar to all oral surgeons, you will be able to have your procedure completed without risk. Be sure to inform our staff of your prescribed medications, particularly Coumadin.

Aspirin is a very safe and effective drug that many people take daily to decrease the risk of heart attacks. This treatment can be continued right through your oral procedure.  Another commonly prescribed medication is Plavix. It can also be taken without fear of excessive bleeding following oral surgery. Physicians are referred to an excellent review in the Archives of Internal Medicine/Vol 158, Aug. 10/24, 1998, entitled “Dental Surgery in Anticoagulated Patients” by Michael J. Wahl, D.D.S. A summary of the article and our personal experience regarding this subject is included below. Unfortunately, there are several documented cases of serious embolic complications in patients when Coumadin therapy has been withdrawn for dental treatment.

“There are virtually no cases of oral bleeding that could not be controlled by local measures, even at PT or INR levels well above the therapeutic range.”

One reported case of bleeding was associated with Erythromycin and one with Amoxicillin used as premedication (see the new guidelines for premedication), but continued beyond the American Heart Association's recommendations. Even extensive oral surgical procedures such as full mouth extraction, alveoplasty, or the placement of dental implants can be accomplished with the patient in a therapeutic range.

Guided by the American College of Chest Physicians and the American Heart Association, we have found patients to do well without any serious bleeding in the recommended therapeutic range of the International Normalized Ratio (INR) of 2.0 to 3.0 for all conditions except for mechanical heart valves, for which an INR of 2.5 to 3.5 is recommended.

Smoking cigarettes seems to be associated with almost all postoperative complications, including bleeding, slow healing, and even the loss of otherwise highly successful dental implants.

These articles are the property of Musser & Richards, LLC, and may not be reprinted without prior permission.