JNMC SHOCKER NO 2,3,4,5..............: I have a middle aged lady - TopicsExpress

JNMC SHOCKER NO 2,3,4,5..............: I have a middle aged lady who had her mitral valve replaced by a metallic prosthesis at G.B. Pant hospital a year ago. She is on oral anticoagulant warfarin. She also has Ch.AF . She came to me for advice on her warfarin as she was to have tooth extraction at JNMC. I advised her to stop warfarin 3 days prior to tooth extraction and instead take s/c enoxaparin 80mg daily. tooth extraction was to be done on 4th day on which day enoxaparin was to be taken after the extraction once bleeding stopped in the evening. she was to continue enoxaparin while her warfarin was restarted till INR was above 2.5. In JNMC the dental surgeon asked her to stop warfarin for 4 days without heparin which was to start on day of tooth extraction!(presumably on advice of a physician/cardiologist) When i was informed that her warfarin was discontinued and no heparin being given, i doubled her dose of warfarin and sent her to delhi to her heart center to seek proper advice.

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