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BDS2 BAMS > Acquired bleeding and anticoagulants > Flashcards

Acquired bleeding and anticoagulants Flashcards

1
Q

What is thrombophilia?

A
  • Increased risk of clots developing
  • Often an acquired condition superimposed on a genetic condition
  • Usually possible to find a cause for the clot
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2
Q

What are possible inherited causes of thrombophilia? (4 points)

A
  • Protein C deficiency
  • Protein S deficiency
  • Factor V Leiden
  • Antithrombin III deficiency
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3
Q

What are acquired causes of thrombophilia? (7 points)

A
  • Antiphospholipid syndrome
  • Oral contraceptives
  • Surgery
  • Trauma
  • Cancer
  • Pregnancy
  • Immobilisation
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4
Q

What is thrombocytopenia?

A
  • Reduced platelet numbers
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5
Q

What is a qualitative disorder?

A
  • Normal platelet number but abnormal function
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6
Q

What is thrombocythemia?

A

Increased platelet numbers

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7
Q

What are the possible causes of thrombocytopenia? (3 points)

A
  • Idiopathic
  • Drug related (alcohol, penicillin’s, Heparin)
  • Secondary to lymphoproliferative disorder
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8
Q

Dental treatment can proceed safely providing the platelet count is what?

A

> 50*10^9

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9
Q

Are inherited qualitative disorders common or rare?

A

Rare

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10
Q

What are examples of acquired qualitative disorders? (4 points)

A
  • Cirrhosis
  • Drugs
  • Alcohol
  • Cardiopulmonary bypass (tend to have platelets that don’t work well)
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11
Q

Is thrombocythemia common or uncommon?

A

Uncommon disease

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12
Q

What medication are patients with thrombocythemia usually on to prevent clot formation?

A

Usually on aspirin

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13
Q

What are common causes of liver disease? (3 points)

A
  • Alcohol
  • Hepatitis
  • Drug indiced
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14
Q

What is the value of a normal INR?

A
  • 1
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15
Q

What is the haematological change in haemoglobin in liver disease?

A

Little change

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16
Q

What is the haematological change in platelets in liver disease?

A

Decrease

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17
Q

What is the haematological change in PT in liver disease?

A

Increase

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18
Q

What is the haematological change in APPT in liver disease?

A

Increase

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19
Q

What is the haematological change in TT in liver disease?

A

Increase

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20
Q

What does PT mean?

A

Prothrombin time

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21
Q

What does APTT stand for?

A
  • Activated Partial Thromboplastin Time
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22
Q

What effect does mild stage liver disease have on dental surgery?

A
  • Blood results often normal so normal precautions apply
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23
Q

What effect does moderate stage liver disease have on dental surgery? (3 points)

A
  • Often only one parameter abnormal and platelet count >100
  • No problem with treatment
  • Local measures following extraction
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24
Q

What effect does severe stage liver disease have on dental surgery? (3 points)

A
  • All blood results abnormal
  • Problems with haemostasis
  • Extractions MUST be carried out in conjunction with haematologist
25
Q

What are 3 examples of anti-thrombotic medication?

A
  • Oral anticoagulation (swallow - not injection)
  • Heparins (injection)
  • Antiplatelet medication (by mouth)
26
Q

What are possible indications for anticoagulation? (5 points)

A
  • Atrial fibrillation
  • Deep vein thrombosis
  • Heart valve disease
  • Mechanical heart valves
  • Thrombophilia
27
Q

What are 3 subtypes of oral anticoagulants?

A
  • Coumarins
  • Direct Factor Xa inhibitors
  • Direct Thrombin Inhibitors
28
Q

What is an example of a coumarin (type of oral anticoagulant)?

A
  • Warfarin
29
Q

What are 2 examples of direct factor Xa inhibitors (type of oral anticoagulant)?

A
  • Rivaroxaban

- Apixaban

30
Q

What is an example of a direct thrombin inhibitor (type of oral anticoagulant)?

A
  • Dabigatran
31
Q

Give 3 examples of new oral anticoagulants?

A
  • Rivaroxiban
  • Apixiban
  • Dabigatran
32
Q

Why are new oral anticoagulants increasing used over warfarin?

A
  • They are ‘safer’ and ‘cheaper’ alternative

- No monitoring needed routinely

33
Q

What is the daily dose of warfarin?

A

1-15mg

34
Q

What is the response of warfarin measured by?

A
  • Measured using the INR
35
Q

When should the INR be checked for someone on warfarin?

A

Every 4-8 weeks

36
Q

What are examples of potentiating drugs when combined with warfarin? (4 points)

A
  • Aminodarone
  • Antibiotics
  • Alcohol (with liver disease)
  • NSAID’s
37
Q

What are examples of inhibiting drugs when combined with warfarin? (4 points)

A
  • Carbamazepine, barbiturates
  • Cholestyramine
  • Griseofulvin
  • Alcohol (without liver disease)
38
Q

What are examples of medicines you should use with caution when a patient is on Warfarin? (3 points)

A
  • Aspirin (as an analgesic)
  • Most antibiotics (amoxycillin least likely to cause problems)
  • Azole antifungal drugs (fluconazole, itraconazole)
39
Q

What should you assume with warfarin?

A
  • Assume all drugs interact with warfarin
  • Always seek advice from GP if you are prescribing
  • INR check needed in 24-48hrs
40
Q

What is the INR (international normalised ratio)?

A
  • INR= Patient PT/ mean normal PT
41
Q

What is the target INR for patients with mechanical heart valves?

A

3.0-4.0

42
Q

What is the target INR for patients with recurrent VTE while adequately anticoagulated?

A

3.0-4.0

43
Q

What is the target INR for patients with atrial fibrillation?

A

2.0-3.0

44
Q

What is the INR range that you roughly want a patient to be in?

A

2.0-4.0

45
Q

What is a common risk of being on warfarin?

A
  • HAEMORRHAGE RISK
  • 1% per annum risk of serious bleed (needing hospitalization/transfusion)
  • 25% of these are fatal
46
Q

What are common risks of adjusting a patients INR? (4 points)

A
  • Fatal thromboembolic events
  • Non-fatal thromboembolic events
  • Rebound hypercoagulable st ate
  • Restarting warfarin makes coagulation more likely
47
Q

What are examples of dental treatments where the INR must be checked? (4 points)

A
  • Extractions
  • Minor oral surgery
  • Periodontal surgery
  • Biopsies
48
Q

What are examples of dental treatments where the INR is not checked? (4 points)

A
  • PRosthodontics
  • Conservation
  • Endodontics
  • Hygiene phase therapy
49
Q

What are the SDCEP guidelines in relation to giving injections on a patient on warfarin? (3 points)

A
  • Use a LA containing a vaso-constrictor
  • Where possible use an infiltration, intraligamentary or mental nerve injection
  • If there is no alternative an inferior alveolar nerve block is used the injection should be administered slowly using an aspirating technique
50
Q

When should you treat a patient on warfarin?

A
  • In the morning, early in the week
51
Q

When must the INR of a patient on warfarin be checked prior to dental treatment?

A
  • Must be checked in the 48 hours prior to treatment but should be as near as possible to the time of treatment
52
Q

What must the INR of a patient on warfarin be so dental treatment can proceed?

A

must be <4.0

53
Q

When extracting teeth on a patient on warfarin. How many teeth should you remove at a time?

A
  • No more then three roots
54
Q

What are local measures to aid haemostasis of a patient on warfarin after having dental treatment? (4 points)

A
  • LA infiltration
  • Oxidised cellulose
  • Sutures
  • Pressure
55
Q

What are good post operative instructions to give to a patient on warfarin after being given dental treatment?

A
  • Must include emergency contact details
56
Q

How are unfractionated heparins administered?

A
  • Given by IV infusion in hospital

- Very short half life so very controllable

57
Q

How are low molecular weight heparins administered?

A
  • Given by subcutaneous injection by the patient at home

- Dose weight related - no monitoring

58
Q

What are examples of drugs available as antiplatelet medication? (4 points)

A
  • Low dose aspirin (75mg daily)
  • Clopidogrel
  • Dipyridamole
  • Ticlopidine
59
Q

If a patient is on an anticoagulant and antiplatelet therapy, what should you do?

A
  • Discuss with a hospital therapist

- Each individual case is slightly different

BDS2 BAMS (57 decks)

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