Pulmonary Embolism Support Group
By far the most common form of pulmonary embolism is a thromboembolism, which occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. Symptoms may include difficulty breathing, pain during breathing, and more rarely circulatory instability and death.
One wisdom tooth (the only one remaining) has to be removed now. It is the second anchor to a bridge and the bridge needs to be be sectioned so I don't loose the bridge. I know being on Warfarin is a concern, but the last time I had surgery my GP took me off my Warfarin for 5 days and a day after surgery I ended up in the ER. I couldn't explain it but am glad I went because my INR was 1.0. I needed my Warfarin and Arixtra shots to help me get my number up. So what/how do I approach said GP about not having coverage for this time frame. My INR is finally 2.3 and I don't want to mess it up too much. Its taken since February 3 to get it to this.
http://www.fvleiden.org/ask/109.html
Though I have a thrombophilia specialist, my local physician at the Naval Hospital often leaves the decision up to the dentist, while the dentist often asks what the physician recommends.
The only thing I caution is, "if" they decide on bridging you, make sure you are off Lovenox/Fragmin at least 12-24 hours before they give you any type of block in regards to anesthesia.
As far as the INR, when I had my hip replacement back in December I had always had any easy INR to maintain (since 2001). Though I was off Coumadin for only about 4 days, then placed on Lovenox until the day before the surgery, it took six weeks to get my INR from 1.1 back to 2.0-3.0. So I relate to what your concerns are.
Regards,
Tom in Connecticut
I talked to my doctor and he is fighting me on using the Lovenox. Why this such a big deal to him I don't know. He said he would give me the Lovenox but I would have to come in daily to have blood checked (he charges an office visit for each blood check) and the Lovenox is "hundreds of dollars".
Last time my INR was 1.6 or 1.7 before surgery and I went to 1.0 after surgery and ended back in the ER because of it. Then it was a mess trying to get it to any sense of a normal range until last week. Now it is 2.3. (Excuse me for a minute I need to scream - lol.)
I tested positive for FVL so Warfarin will be with me from now on. I just don't like the ideal that if I need to have anything done my doctor wants me off of it with no bridge for at least 5 days each time. I tried to have my oncologist who is a hemotologist manage this but prefers to follow up on it and have my GP manage it. Yes I so need a new GP (mine is retiring soon any way) but wanted to get my INR stable before going to a new doctor.
Anyone in Maryland know a good doctor - lol?
If JHU is closer, I can find a name of a specialist there from a colleague of mine who works at the Cancer Center there.
Even having FVL does not necessarily commit you to a lifetime of Coumadin. Do you know if you are heterozygous or homozygous for FVL?
Okay, going back to the discussion at hand, it appears that using the guidlines from the link I mentioned you should be able to remain on Coumadin. You mention your GP's concerns, how does your dentist feel about being on Coumadin for the surgery? I'm in the same boat as you when it time for any dental work (it becomes frustrating). My only grace is I know two specialists and often consult with them in regards to what I should do.
Georgetown would be a nice day trip for us. JHU is closer and my oncologist does second opinions and has other connections with JHU. I did go for a second opinion on my reconstruction options a few years ago and in this area I was none the happy about the specific surgeon I saw and ended up going with Dr. Bernard Chang at Mercy Medical Center in Baltimore. But other areas may be different. By all means I am open to other providers that can help me manage this.
It seems as the dentist will follow the GP's guidelines on the Warfarin. Dr Chang did a procedure for me a few weeks ago and he followed the GP's guidelines.
At this point for the dental work I have decided to do a consulting appointment and a procedure appointment a week later so I will not have to be off Warfarin for an extended period of time. However I do need to find a doctor to manage this as I am not hapy about having to fight with my doctor about all of this and then some.
By the way I mentioned this to my regular dental practice and they said they don't have concerns treating patients on Warfarin. They just like to know this information of course.
I am have oral surgery to remove a very complicated wisdom tooth so I have to use caution as bleeding may be more then if I had say a filling. I should be good dental wise after this tooth and will make sure to make my cleaning appointment to keep things looking good. I almost forgot how bad a toothache could be. Not something I want to mess with.