Expert: Ronald Levy, M.D. - 12/3/2009

Question
is anesthesia best given in a hospital for extensive dental procedures on patient taking coumadin (repeat ... extensive) .how is bleeding controlled.

Answer
Generally I would say yes only because it will be easier to deal with possible complications but it can be done in a well equipped outpatient center. As far as bleeding control, usually the patient is stopped on the coumadin several days before and started on IV Heparin (another reason why a hospital is better). The Heparin is stopped several hours before surgery and then restarted afterwards until the Coumadin levels return. If this is done outpatient, they would not stop the Coumadin but the risk of bleeding is higher. The patient would still have 1 out of 3 clotting mechanisms working (Platelets) but hemostasis would still be more important in these cases.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston