Tooth extraction

I am due to have my tooth out soon at hospital,will I have to stop my warfarin due to risk of bleeding more when tooth extracted.also prescribed erythromycin to take but do they interfere with inr.any advice appreciated.

5 Comments

Wow - you have a...

by donr - 2014-01-25 09:01:07

...bunch of issues to face!

Sylvia: I assume from reading all your posts that YOU also host an ICD. That's what your post on the meaning of NYHA says.. It also says you have A-Fib. The Warfarin is to protect you from stroke that can be brought on by A-Fib.

IF you take Warfarin, of course it will affect yout INR - it's sole purpose in treatment is to INCREASE your INR. The INR is normally 1; take Warfarin & it increases. That tells the Dr. that your blood clots LESS easily & takes longer to form clots.

Usually for a tooth extraction they want your INR back close to 1 for the procedure. You did NOT specify what your normal INR is while taking Warfarin. Your DR's instructions are very critical in this case - I will not try to guess what they are. It usually takes 5 days to reduce your INR after stopping Warfarin.

When you have teeth extracted, especially big molars in the rear of the mouth, it is not uncommon to bleed a bit, so they want you to clot easier than the Warfarin will allow it to do so that the hole where the tooth was heals faster.

Erythromycin does not normally affect INR. The Erythromycin is to combat any bacteria normally growing in your mouth to get into the open wound caused by the extraction and then into the blood stream. If that happens, many infections can grow on your ICD or the leads in the heart.

I see that you live in the UK. I am in the US & our practices for tooth extractions are different from yours sometimes.

We are usually given Clindomycin for an antibiotic; we do usually have to reduce our INR back to 1 for the procedure. If we are sent to the hosp for the extraction, it is considered a risky procedure for us, hence the additional precaution of the hospital venue for the procedure.

What I have told you is from the US perspective, I think it is pretty close to yours - Ian & Yatman will hopefully chime i & give you local advice.

I hope I have started you off OK.

The best to you in the procedure.

Don

I just read SPARROW's comment ...

by donr - 2014-01-25 10:01:49

...explaining NYHA criteria.

Now I see why you are going into a hosp for the extraction - you are probably considered a risky case being NYHA 3-4.

Sounds like your Dentist is looking out for you.

Don

Warfarin, antibiotics, teeth extracted

by JerryG - 2014-01-26 06:01:02

I recently had 5 teeth extracted including some big molars. I am on watfarin and keep my INR in the 2-3 range as instructed by my cardio to minimise the stroke risk caused by afib.

I stopped my warafrin 4 days prior to the extraction. I test my own INR (with an Alere INRatio2 meter) and it was 1.16 on the day of the procedure which my dentist was quite happy with. He prescribed 3000mg amoxycillin to be taken 1 hour before the procedure and everything went fine; no serious bleeding and no infection. The dentist said I could resume warfarin the day after the extraction, not the same day as he is obviously cautious.

The antibiotic used varies from country to country and even between dentists in the same country. However, the common idea is to kill all bacteria in your mouth before the extractions are done so you do not later develop a serious infection with the bacteria getting into the open wounds. Most antibiotics interact with warfarin (over 400 drugs interact with warfarin) but as the antibiotic in this case is a 1-time dose taken when you have temporarily stopped warafrin anyway, there is no problem.

I live in the bush in South Africa with few medical facilities anywhere close!

Inr

by Sylvia1 - 2014-01-26 06:01:49

Tks don,jerry and ian for advice re tooth extraction.my inr is usually 2.7,so when I have my consultation at the hospital this week I will see what they say about when to stop warfarin.i will also ask about antibiotics as when the dentist gave them to me to take I did not take them as had read they can interfere with inr which has taken me ages to get and keep at 2.7.i was prescribed erythromycin as I am allergic to penicillin,but will ask pharmacist if there is another antibiotic I could take.the tooth is painful now and needs to come out as soon as.

Hi Sylvia

by IAN MC - 2014-01-26 08:01:15

Jerry has given a very clear summary of your likely procedure i.e. 4 days off warfarin to allow it to get out of your system BUT I would still not be happy taking erythromycin.

There is quite a strong interaction between erythromycin and warfarin; the combination can make you bleed more !

Even though it will probably be OK with a 4 day interval if it were me, I would rather take a different antibiotic .

Ian

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