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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Taking Coumadin For A-fib. Can Coumadin Be Stopped Temporarily For Tooth Extraction?

I have Afib caused by a valve replacement . I have been on coumadin for a number of years and is monitored by the VA clinic. I have to have some dental work done, tooth extraction and cleaning. The VA recommended I stop the coumadin 4 days before my appt. and start up after the dental work is completed. I felt this was an unnecessary risk do to the risk of a stroke. I would appreciate your opinion on this matter. Thanks
Mon, 23 Sep 2013
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Dentist, Pedodontics,  's  Response
Thank you for sharing your concern in HCM forum. In modern dentistry there is no need to stop Coumadin( warfarin sodium) before simple dental procedure like extraction of one tooth, scaling etc. A test of International Normalized Ratio(INR) of Prothrombin time status has to be done within 48 hours of procedure. A result of INR Less than 4.1 is safe to continue simple dental procedure. If it is more, the procedure should be postponed and the dosage of warfarin should be adjusted to bring the INR 4.1. In intensive surgical procedure like wisdom tooth extraction INR should be bring down below 3.5. But no way the warfarin should be stopped. There is a chance of little more bleeding. But that can be easily controlled by local measures like pressure or a dressing with some haemostatic agents. DO NOT STOP WARFARIN. THERE IS NO NEED. IF REQUIRED, CONSULT ANOTHER DENTIST WHO IS HAVING KNOWLEDGE OF MODERN MEDICAL SCIENCE.
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Taking Coumadin For A-fib. Can Coumadin Be Stopped Temporarily For Tooth Extraction?

Thank you for sharing your concern in HCM forum. In modern dentistry there is no need to stop Coumadin( warfarin sodium) before simple dental procedure like extraction of one tooth, scaling etc. A test of International Normalized Ratio(INR) of Prothrombin time status has to be done within 48 hours of procedure. A result of INR Less than 4.1 is safe to continue simple dental procedure. If it is more, the procedure should be postponed and the dosage of warfarin should be adjusted to bring the INR 4.1. In intensive surgical procedure like wisdom tooth extraction INR should be bring down below 3.5. But no way the warfarin should be stopped. There is a chance of little more bleeding. But that can be easily controlled by local measures like pressure or a dressing with some haemostatic agents. DO NOT STOP WARFARIN. THERE IS NO NEED. IF REQUIRED, CONSULT ANOTHER DENTIST WHO IS HAVING KNOWLEDGE OF MODERN MEDICAL SCIENCE.