I had aortic valve surgery and I'm taking an anticoagulant (Comodin/warfarin). How many days before a tooth extraction should I stop it?

Seek urgent care if any of the following occur before or after the dental procedure:

• Uncontrolled oral bleeding
• Chest pain or sudden shortness of breath
• Fainting or loss of consciousness
• Sudden weakness in face/arm/leg or new speech difficulty

If any of these signs are present, go to the emergency department immediately.

Before the procedure coordinate with the following professionals:

• Your dentist (procedure type and local bleeding control)
• Your cardiologist or anticoagulation clinic (evaluate valve type, thromboembolic risk and anticoagulant management)
• Your pharmacist (information on the specific anticoagulant and interactions)

These clinicians should agree on a plan; do not make changes on your own.

Typically the following are assessed before planning the extraction:

• Type of prosthetic valve (mechanical or bioprosthetic)
• Exact anticoagulant and timing of last dose
• Most recent INR or other relevant coagulation tests
• Type of dental procedure (simple extraction versus surgical) and general health status (eg kidney or liver function)

Missing information affects planning; bring available records or lab results to consultations.

Final decisions are individual and made by your clinicians, but common strategies include:

• Temporary modification or short interruption of anticoagulation in some cases
• Consideration of bridging with short-acting anticoagulation for high thrombotic risk such as mechanical valves
• Use of local hemostatic measures by the dentist to reduce bleeding during and after the extraction

These are general points; your cardiologist, anticoagulation clinic or pharmacist will advise specifics.

Watch for the following after the extraction:

• Persistent or increasing bleeding
• Difficulty swallowing or breathing
• Fever, severe pain or worsening of the surgical site

Contact your dentist or seek emergency care if these occur.