I had a TIA while on Plavix and aspirin (both antiplatelets). I now take an anticoagulant (vitamin K antagonist, similar to Warfarin). Ive bridged a couple of times without any problems (I also self-test my INR so I know when Im in range and when to start bridging). Not much fun, but no big deal. As far as I know, heparin works for 24 hours which is why you stop 24 hours before the procedure in the hospital they give you heparin anyway so there is no problem there. Then at home I bridge again until Im back in range. Easy.

The article is interesting BUT somehow I have problems trusting professionals who talks about anticoagulants using the term blood thinner. Anticoagulants DO NOT thin the blood anticoagulants slow the clotting time (depending on what you take it targets a different factor or factors in the clotting cascade).

As for the statistics they presented it looks like the chances of stroke is miniscule in both cases. So no use in freaking out. Youll be fine, listen to your doctor and pharmacist.

Carpe diem,
across the pond (atp)

Thank you for the encouragement. This will be the first time I will have had to be off of the xarelto. They don't bridge with anything when you are taking it. Although 48 hours seems excessive to me for an extraction I've decided to just work on my extreme anxiety about dentists and being off of xarelto. I'm embarrassed for being such a wimp.

I am on warfarin. When I had hip surgery in Nov they had to bridge me with Lovenox not sure of the spelling. But I was back on the warfarin by the time I left rehab.

Thanks for linking to that interesting article from Duke. Studies like this can really help in the development of practice guidelines which will benefit us all.

The study only applies to warfarin, not other anticoagulants. It may be that the heparin doesn't cause as much bleeding with some lower level of the NOACs. Another thing... these numbers include people with different CHA2DS2Vasc scores. A decent study would have looked at who had the strokes and who had the bleeds (by CHADS and HASBLED scores). Also, if someone hasn't been in afib (or in and out) around the time of surgery, their risk would be lower. These studies that look at diverse patient populations and try to generalize do not impress me. Finally, barring any "rebound" effect of withholding warfarin, risk over hours is very low anyway. If your risk is 4% annually (a 4 CHA2DS2Vasc score,which is pretty high), it is about .01 of 1%. That's 1/100th of 1%. Probably stroke risk goes up if you are getting cut or burned though.

Takeaway: It's about ABSOLUTE risk. Stroke risk over one day is very low anyway (with or without bridging). What matters is your own medical conditions, HAS BLED score CHA2DS2Vasc score, and current AFIB burden (if you are currently in afib or switching back and forth, which is worse).

Stroke is serious business. Being concerned as a patient is understandable. I heard someone quote a doctor saying to a patient: "A minor health concern is a medical problem that you have. A major health concern is a medical problem that I have". Of course, that probably never happened, but you get the idea. petey