anticoagulants and antiplatelets Flashcards
dental procedures with a high risk of post op bleeding complications
- complex extractions/ adjacent extractions that will cause a large wound or more than 3 extractions at once
- flap raising procedures
- biopsies
- gingival recontouring
what patients should anticoagulant or antiplatelet therapy never be interrupted
- patients with prosthetic metal valves
- coronary stents
- pulmonary embolism or DVT in last 3 months
- patients on anticoagulant therapy for cardioversion
advice for treating patients taking DOACs ( apixaban, rivaroxaban, dagibatran)
low risk of bleeding complications - no interruption to medication
high risk of bleeding - miss morning dose or delay daily dose if taken in morning
advice for treating patients taking warfarin or other vit k antagonist (phenindione, acenocoumarol) for bleeding risk procedures
check INR ideally within 24 hours of appt, up to 72 hours if pt stable
if INR below 4, treat without interupting medication
if above 4, delay tx or refer if urgent
what patients are at increased risk of developing infective endocarditis
(sub group for specific consideration)
- previous IE
- prosthetic valves
- congenital heart disease
antibiotic prohylaxis for IE if required
amoxicillin, 3g 1 hour before procedure
OR if penicillin allergy
clindamycin 300mg 1 hour before procedure
what is defined as a stable warfarin patient
a stable patient would be one who does not require
weekly monitoring and who has not had any INR measurements above 4 in the last two
months.
if delayed daily dose (rivaroxaban, edoxaban) when can the patient take their medication
need to wait at least 4 hours post haemostasis
general advice principles for treating patients on anticoagulant therapy
appointments early in the day and early in the week
perform procedures as atraumatically as possible
stage treatment where possible
Avoid recommending NSAIDs for pain relief
suture and pack extraction sockets
