Coumadin and Dental Procedures

I'm a 44 year old male.  On 10/22/97 I had heart surgery.  I had an
aortic aneurysm, which necessitated an aortic root replacement: along
with a prosthetic aortic valve.  

Since surgery I've been on 3 medications.  Coumadin, which I will need
the rest of my life, vasotec, and paxil.

I'm scheduled to have dental work done within a week.  I will need a
crown, because one of my fillings chipped off.

One dentist claims that I will need to be off coumadin for several days
prior to the procedure.  The nurse who takes my pro-times said, in that
case, I would have to give myself injections  of heparin, during the
time period in which I'm off coumadin.

Another dentist claims that there will not be enough blood loss to
necessitate getting off coumadin.

The question I have is, What is the general consensus on this matter?
My pro-time generally fluctuates between 2.3 and 3.8  My target range is
between 2.5 and 3.5

[Cleveland Clinic, MD]

It depends on how much blood is expected during the procedure.  I would probably recommend holding the coumadin for a couple of days prior.  Whether you will need replacement heparing during those couple days is a judgement call up to your physician.  There is a small but potential risk of developing a blood clot while you are off the coumadin.  The bottom line here is that your dentist and doctor will need to communicate with each other and come up with the best "game plan" for you.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.