anti-coagulation

Question 1

what is an example of injectable anticoagulant?

Answer 1

heparin

Question 2

is a low molecular heparin dentally relevant?

Answer 2

no- it is a short term subcutaneous injection

Question 3

what are examples of oral anticoagulants?

Answer 3

warfarin
rivaroxaban
apixiban

Question 4

what are high risk procedures in dental setting?

Answer 4

biopsy
complex extraction
flap raising procedures

Question 5

what are low risk procedures?

Answer 5

simple extraction
rsd
subgingival restorations

Question 6

what procedures are unlikely to carry a bleeding risk?

Answer 6

supra restoration
pros
Endodontics
bpe
IBD
LA

Question 7

what common conditions require anticoagulants?

Answer 7

atrial fibrillation
mechanical heart valves
DVT
thrombophilia

Question 8

does warfarin have a slow or fast onset?

Answer 8

slow- increased risk of clot at start of treatment

Question 9

what would be given if a patient on warfarin had excessive bleeding post surgery?

Answer 9

vitamin k injection

Question 10

what does INR stand for?

Answer 10

international normalised ration

Question 11

what does INR measure?

Answer 11

prothrombin- time taken for blood to clot

Question 12

what is the normal INR for warfarin users ?

Answer 12

2-3

Question 13

what is the INR of warfarin users with prosthetic valves/DVT?

Answer 13

3-4

Question 14

when should INR be checked before treatment?

Answer 14

no more than 72 hrs before but 24hrs before is best

Question 15

how often should INR be checked?

Answer 15

every 4-8 weeks

Question 16

what does SDCEP say is an ok INR to proceed?

Answer 16

below 4- proceed with caution

Question 17

what should be checked alongside INR before invasive treatment?

Answer 17

INR and FBC

Question 18

when is it best to treat patients taking anticoagulants?

Answer 18

in the morning at the start of the week

Question 19

what local haemostatic measures should used when treating patients?

Answer 19

LA- around socket to reduce blood flow
cellulose sponge
sutures

Question 20

what should be given post op?

Answer 20

post op instructions
out of hours number

Question 21

what drugs increase the action of warfarin?

Answer 21

NSAIDS
antibiotics
alcohol
anti fungal- “azoles”
aspirin

Question 22

what does NOAC stand for?

Answer 22

new oral anticoagulants

Question 23

do NOAC have rapid or slow onset?

Answer 23

rapid

Question 24

do NOAC require monitoring/INR?

Answer 24

no

Question 25

do NOAC have a short or long duration?

Answer 25

short

Question 26

what are examples of NOAC?

Answer 26

rivaroxaban 1 daily
apixaban - 2 daily

Question 27

if a patient is taking NOAC and the procedure has a low risk of bleeding what should you do?

Answer 27

treat early in day/week
-no changes to med

Question 28

if a patient is taking NOAC and the procedure has a high risk of bleeding what should you do?

Answer 28

-treat early in day/week
-limit initial treatment to assess bleeding
-delay dose until after treatment
or omit first and take second twice
-always use local haemostatic measures
-keep for 20 mins after

Question 29

what are examples of anti platelet drugs?

Answer 29

aspirin
clopidogrel

Question 30

should you stop anti-platelets before treatment?

Answer 30

NO

Question 31

what should you avoid with aspirin?

Answer 31

NSAIDS

Question 32

if taking dual anti platelets what should be done before treatment?

Answer 32

reduce 1 if possible