Post Ablation Bridging For Surgery

I had a Natale Ablation with LAA isolation in February and have been on Eliquis since.

A month or so ago I had a 20+ year old root canal get reinfected resulting in a recommendation for an Apicoectomy which the Endodontist won't perfrom without me being clear of Eliquis fo 2 days. Bringing this to the attention of the NP following my case after my ablation I was told that I could bridge no Eliquis with Lovenox injections every 12 hours for those two days, have the last injection exactly 12 hours before the surgery and take my first Eliquis immediately after the surgery.

The kicker and reason for this post is she also recommended against the Endodontist using Epinephrine, (Adrenaline), unless he needed to. Apparently the adrenaline increases heart rate but also dries up blood flow in the area so the Endodontist needs it to see what he's doing in there. He promised to use as little as possible and none in the anasthetic.

I have been in NSR since my ablation but have a couple more months to go on Eliquis before I can have the TEE to see where we go from here on NOAC's.

Do I delay the dental surgery as long as possible or take the risk of some adrenaline stimulation?

Do the surgery. The last thing you need is an oral infection, which poses its own threat to your heart because the lymphatic system of the mouth drains into the chest. That's how people end up with endocarditis from dental infections. The dose of adrenaline you're going to get is probably less than your body would produce on its own given a good bit of excitement.

My daughter in law is a periodontist so I just called her to see if an Apicoectomy can be done without Epi. Her reply it’s up to the dentist but one has to see what they are doing (bleeding prevents this) and she gives epi.

Good luck! 100% of the time when I get a skin biopsy from my dermatologist and get linocaine (plain without epi) at the dentist for fillings, I always ask no epi. But your dentist maybe right. At least he will try to limit the amount of epi he uses.

Are you on multaq or flecainide?

Very interesting. Last Oct had middle upper front tooth with an infected 50 year old root canal pulled and a zirconia implant placed. I'm not on any anticoagulation, so that wasn't an issue. I asked for no Epinephrine, which we discussed and the periodontist complied. Then, my bone wasn't really hard enough for the implant, so it had to be removed in December. I did that with no painkiller. It got a little painful when she was cleaning up where the implant had been. Bone is now ready for the implant, which I will get at the end of the month. I'm guessing there is less worry about seeing things with what I've had done.

I play around a lot with high dose melatonin powder, including topically. In Oct, I asked if I could use it after the procedure. She agreed, as long as I didn't touch the implant. So, when I got to my car, I dumped around 300 mg in the saliva in the bottom of my mouth and then gently moved the saliva around to get it on the area of the procedure. I could tell the injected painkiller had completely worn off about 15 minutes into my 30 minute drive home as my mouth no longer felt numb. Possibly because of the topical melatonin (which I continued to apply), I never had any pain that day or thereafter. My wife had a cracked molar extracted as the beginning of an implant procedure about a month before me. She had a lot of pain for weeks, but didn't use the melatonin. Could be a bigger tooth, I don't know. I plan to use the melatonin again when the implant is placed.

I'm not suggesting others do this. I always investigate things I experiment with very carefully and understand the risks before I play around. Just relaying my experience. I'm also have no comorbidities and am on no meds except infrequent flec on demand.

Not on anything cardiac except Lisonpril and Eliquis. I have some Atenolol should the rate should get out of control, which is hasn't.

Kardia every week since Feb. 11 ablation has shown NSR with pulse rates around 85.

Went ahead with surgery. Cardiologist and Endodontist agreed to use Carbocaine w/o Epinephrine for pain and inject minimal Epinephrine into the would to keep the blood from covering the tissue being treated. I noticed no adrenalin surge, rapid heartbeat or the like. I certainly did notice that the Carbocaine didn't last very long wihtout the additative.

Soon it will be time for delayed Colonoscopy so I presume the same procedure will be used.

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ggheld
Soon it will be time for delayed Colonoscopy so I presume the same procedure will be used.

Yeah, except no need for the adrenaline.