25. Hemorrhagic diathesis. Dental management of the patients.

Question 1

Groups of bleeding disorders

Answer 1

• Vascular disorders
• Thrombocytic disorders
• Hemorrhagic disorders

Question 2

Causes of Vascular disorders

Answer 2

Alterations in vascular walls of capillaries

Hereditary hemorrhagic telangiectasia or
Rendu–Osler disease, Ehlers–Danlos disease, von
Willebrand disease

Question 3

Causes of thrombocytic disorders

Answer 3

• Decreased numbers of platelets
• Congenital functional abnormality of platelets

Primary or idiopathic
thrombocytopenia, Glanzmann’s disease, and
thrombocytosis or thrombocythemia.

Question 4

Causes of Hemorrhagic diseases

Answer 4

• Disorders of coagulation
• Deficiency of coagulation factors
• Presence of anticoagulants in blood

Inherited disorders of coagulation (hemophilias and deficiency of other factors) and acquired disorders of the prothrombin complex (vitamin K deficiency),
severe liver disease, and excessive use of various
coagulation factors.

Question 5

Dental management of patients with Hemorrhagic diathesis

Answer 5

• Surgical procudure carried out in morning
• Administration of medication by hematologist
• Limiting appoitments to as few as possible
• Anaesthetics with vasocontrictors for better hemorrhage control
• Good bleeding control- smoothing bone edges, absorbable gelatin sponge, suturing and gauze biting
• Avoidance of aspirin

Question 6

Uses of anticoagulants

Answer 6

* Cardiovascular conditions(MI, vascular grafts)
* Cerebrovascular accidents
* Conditions involving veins(pulmonary embolism, venous thrombosis)

Question 7

Most commonly used anticoagulant drugs

Answer 7

• Coumarin drugs
• Heparin drugs
• Anticoagulant derivatives-Acetylsalicylic acid(aspirin)

Question 8

Coumarin Drugs

Answer 8

• Increase prothrombin time to 2-2.5 times normal value(11-12s)
• Delay or prevent coagulation
• Decreased plasma clotting factors II, VII, IX, and X
• Increase risk of post op bleeding

Question 9

Measurement for anticoagulation

Answer 9

• International normalised ratio
• Should be between 2-3(venous thrombosis prophylaxis or 2.5-3.5 (prosthetic heart valves)

Question 10

Management of patients on Coumarin drugs

Answer 10

• Consultation with hematologist so dose reduced before surgery
• Extractions or minor osteotomies performed at INR- 2-3.5
• Prothrombin time should be 1.5 times normal level(max)
• Reduction of dose 2 days beforehand
• After surgery dose increased to normal over 2 days

Prothrombin time should be 17-19s on day of surgery

Question 11

Heparin drugs

Answer 11

• Administered to hospitalised patients
• Parenterally
• 4-8h effect
• Discontinued 4 hours before treatment and can be administered again on same day

Question 12

Low molecular weight heparin

Answer 12

• Prevention of DVT
• Do not need to adjust dose beofe procedure

Question 13

Aspirin containing compounds

Answer 13

• Discontinue 2-5 days before treatment and may continue 24 hours later