Dentaltown October 2022 - 25

Bowser161
I've had a St. Jude mechanical aortic valve for seven years. My Coumadin regimen keeps my
INR just shy of 3.5 as a norm. You would be surprised how little I bleed when I get cut, or even
when I get a bloody nose from time to time. When I fi rst got the valve and started Coumadin,
I thought it was going to be Niagara Falls whenever I got a paper cut, but I clot just fi ne, even
with an INR right at the upper limit of the therapeutic range. ■
8/13/2015
lux8teef
I tend to agree with this statement. The key part is that you do not make the choice to
stop the Coumadin. Thorough communication with the MD who is responsible for/following
the anticoagulation is key. This includes a thorough description to them of what exactly
you are planning surgically, and I would always describe the worst-case scenario (i.e., badly
broken-down previously RCT'ed lower molar that may require a small fl ap and sectioning to
remove) versus just saying " extraction of tooth/teeth. "
As far as the NOACs go, I think most physicians would be in favor of stopping them a day
or so before the procedure, because they have a quicker onset/offset of action than warfarin and
there is no current way to monitor their effectiveness at anticoagulation (like an INR/PT for
warfarin). However, I would still contact the prescribing MD and discuss this with them and
not make the decision to take the patient off the newer novel anticoagulants.
To answer the original question: I think it is tough to say exactly what level of INR makes it
acceptable to control bleeding via local measures. And this control process could take quite some
time, along with a longer period of postoperative observation the higher the INR is at the time
of surgery. Anecdotally, most surgeons I have worked with would like it closer to 2.0, especially
as the number of extractions/invasiveness increases.
Finally, remember that if they are also on dual antiplatelet (ASA plus Clopidogrel) regimens
for whatever reason, this gives another reason why they could bleed longer than usual. ■
Benacel is also a great aid in stopping the bleeding. Have your Benacel plug ready, vacuum
8/16/2015
almunk
out the socket and quickly stuff it full of Benacel, packed in tight. This usually works. ■
Yeah, I forgot the whole point of the INR was to normalize the pro bleeding times across
the board.
So the doctor wrote down that he wants her to be off warfarin for three days before the
extraction, a weekend holiday. I'll get the INR within 24 hours.
Has anyone here been giving patients 5% tranexamic acid rinses, basically a topical
antifi brinolytic?
The OMS in town uses this on his patients postextraction for a day or so. The OMS tried to
scare me from doing extraction on Coumadin patient, though, saying the problem isn't having
problems getting bleeding to stop after extractions but having bleeding start again after the
patient is sent home. Are any thoughts on this being a deterrent? I just don't understand why he
wouldn't want me to take these patients off his load. They can't afford him and are not going to
see him. I know I shouldn't make their fi nancial troubles my clinical troubles, but I think I can
handle these Coumadin patients.
So does anyone do this topical 5% tranexamic acid rinse, and do you recommend it? Also,
what technique are you using to stop the postoperative bleeding with electrosurgery? ■
8/18/2015
Member Since: 12/17/05
Post: 15 of 42
8/18/2015
Saca_Muela
Member Since: 09/22/08
Post: 16 of 42
Member Since: 12/10/11
Post: 12 of 42
Member Since: 10/18/01
Post: 11 of 42
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