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coagulation disorders Flashcards

1
Q

why do you need to know about the anticoagulants or platelets disorders that someone has as a dentist?

A

if they have a clotting disorder and are not on medications, they might bleed to death

those on anticoagulants require tx planning to prevent bleeding risks

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2
Q

what are safe dental procedures that do not require patients to alter their anticoagulant schedule?

A

o hygiene therapy
o pros
o restorative
o crowns
o bridges
o endodontics
o orthodontics

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3
Q

what are risky procedures that dentists need to consider for patients on anticoagulants?

A

minor oral surgery
extractions
perio surgery
implants
biopsies

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4
Q

3 types of antithrombocytic medication

A

1injectable anticoagulants
2 oral anticoagulants
3 antiplatelets

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5
Q

what is unfractionated heparin and when is it used

A

it is an injectable anticoagulant

  • rapid control
  • temporary, only active for a few minutes
  • used for operations, not practical in dental setting
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6
Q

what is low moledular weight heparin and when is it used?

A

it is a type of injectable anticoagulant

injected once daily

does not interfere with dental tx

stops low level excess clotting without increasing bleeding risk

used for short term hypercoagulability, eg when first starting on warfarin

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7
Q

who needs to take anticoagulants

A

form blood clots too easily

pros valves

thrombophillia

atrial fib

DVT

heart valve disease

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8
Q

most common anticoagulants

A
  • warfarin
  • apixaban
  • dabigatran (direct thrombin inhibitor)
  • rivaroxaban
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9
Q

eg of a coumarin and a non coumarin

A

coumarin = warfarin
non coumarin = apixaban

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10
Q

what factor does apixaban inhibit

A

factor x (10)

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11
Q

what factor does warfarin inhibit

A

it is a vitamin k antagonist

inhibits protein c and s

inhibits production of vitamin k dependent clotting factors 2 7 9 10

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12
Q

why do you need to take heparin when you first start taking warfarin?

A
  • initial hypercoagulability due to protein c and s inhibition
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13
Q

what is the acceptable range of INR for warfarin patietns

A

INR 2- 4

checked every 4-8 weeks for stability

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14
Q

what can INR be upset by

A

drug interactions and food

  • warfarin is heavily bound to plasma proteins, other drugs can displace warfarin from the protein
  • anyone taking warfarin has to take caution with other drugs
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15
Q

as a dentist what precautions do you need to take for warfarin patients

A

drug interactions

local haemostatic measures

check INR within 72 hours of a RISKY procedure

emergency out of hours contact

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16
Q

what drugs interact with warfarin

A

assume all drugs interact with warfarin but mainly

nsaids
aspirin
azole antifungals

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17
Q

what are the hazards of taking warfarin?

A
  • haemorrhage during treatment
  • trauma causing serious bleed
  • soft tissue injury leading to bleeding into muscles
  • rapid reversal of anticoagulation with vitamin k injection in hospital
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18
Q

what is the benefits of DOAC over warfarin

A

DOAC has predictable bioavailability so it doesnt require INR testing

it has rapid onset and short duration of action, effects lost within a day

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19
Q

what do you as a dental professional need to know when treating patients on doac

A
  • low risk procedures do not require changing dose of NOAC
  • high risk procedures can delay the morning dose of NOAC, then restart dose after treatment
  • IDB if needed
  • local haemostatic measures
  • keep for 20min post extraction to assess bleeding
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20
Q

what drugs interact with doac?

A

nsaids
carbamazepine
macrolides
erythromycin
clarithromycin

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21
Q

most common antiplatelet drugs

A
  • aspirin 75mg
  • clopidogrel
  • dipyridamole
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22
Q

when must you NOT stop antiplatelet drugs?

A
  • CANNOT STOP in patients with coronary artery stent
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23
Q

antiplatelets vs anticoagulants

A

antiplatelets - inhibits platelet aggregation

anticoagulants - inhibits factors in the coagulation cascade

24
Q

which drugs interact with antiplatelets?

A
  • NSAIDs
  • Carbamazepine
  • Omeprazole

additionally, clopidogrel interacts with erythromycin and fluconazole

25
as a dentist, do you need to stop patients who are taking aspirin before their procedure?
if aspirin alone , no need to stop if taking aspirin with another antiplatelet, need to expect prolonged bleeding and local haemostatic measures essential + Good post operative instructions with emergency contact details
26
what is an inherited bleeding disorder?
acquired defect that affects the coagulation of the blood
27
haemophillia vs thrombophillia
Haemophilia = too little clot formed Thrombophilia = too much clot formed
28
haemophilia A and B affect which chromosome
X chromosome therfore it is sex linked recessive
29
is haemophillia recessive or dominant
haemophillia a and b = sex linked recessive von Willebrand = autosomal dominant
30
which chromosome does von willebrand affect
NOT x chromsome, just autosomal
31
haemophillia A is a deficiency of which factor?
factor 8
32
haemophillia B is a deficiency of which factor?
factor 9
33
von WIllebrand is a deficiency of which factor?
factor 8 deficiency + reduced platelet + Deficiency of von Willebrand factor
34
what are coagulation factor inhibitors
- Are antibodies - That develop after you give treatment ie give factor 8 and 9 - More treatment, more frequent => higher levels of antibodies=> next dose has to be higher than the previous to overcome the inhibitors
35
DDAVP drug function
- aka desmopressin - releases factor 8 that is bound to endothelial cells into the circulation
36
when is DDAVP used?
- used in mild haem a and severe von Willebrand to increase factor 8 in circulation - cannot be used in haemophilia b because there is no factor 9 bound to the endothelial cells
37
Tranexamic acid function and when is it used
function = inhibitor of fibrinolysis, keeps any clots that are formed used when = mild von willebrand and mild haem a
38
treatment for haem a
Severe and moderate – recombinant factor 8 Mild and carriers – DDAVP and oral tranexamic acid
39
treatment for haem b
Severe and moderate – recombinant factor 9 Mild and carriers – recombinant factor 9
40
treatment for von willebrand
Severe and moderate – DDAVP Mild and carriers – oral tranexamic acid
41
which bleeding disorder is quite common but most people do not know
von Willbrand
42
How is haemophillia related to the dental profession?
- Non bleeding procedures done in primary care - Risky procedure done in haemophilia centres/hospital
43
what is considered dangerous local anesthetic for hemophilia patients
1 IDB 2 lingual infiltration 3 posterior superior nerve block
44
for extractions done on haemophillia patients, what is the post operative instructions
severe - observed overnight in haemophillia unit mild - observed for 2-3h after surgery + comprehensive post operative instructions + emergency contact
45
how does thrombophilia occur
- Clot formation > clot breakdown - Excessive stable clot in circulation
46
causes of thrombophillia
- Can be acquired condition superimposed on a genetic tendency o Acquired hypercoagulation o Oral contraceptives o Surgery o Trauma o Cancer o Pregnancy - Could be a problem with fibrinolysis - Could have reduced inhibitors so more clot than normal o Protein c and s deficiency o Antithrombin III deficiency
47
what deficiency can result in thrombophillia
o Protein c and s deficiency o Antithrombin III deficiency
48
what could happen if you have untreated thrombophillia
Clot can embolise and lead to blockage of major blood vessels in the heart and/or lungs (Pulmonary thromboembolism)
49
3 types of platelet disorders
Thrombocytopenia Thrombocythemia Qualitative disorder
50
Thrombocytopenia vs Thrombocythemia
Thrombocytopenia = too little Thrombocythemia = too many platelets
51
penia = reduced
52
causes of thrombocytopenia
- Idiopathic - Drug related - Alcohol - Penicillin - Heparin - Leukaemia - Myelodysplasia - Bone marrow producing excessive numbers of red and white cells with no capacity to make platelets
53
are the platelet function normal in thrombocytopenia and thrmbocythemia?
in thrombocytopenia, normal in thrombocythemia, poor function
54
what is Qualitative platelet disorder
Normal platelets numberbut Abnormal function
55
causes of qualitative platelet disorders?
- Inherited - Acquired o Cirrhosis o Drugs o Alcohol o cabg
56

BDS2 BAMS (27 decks)

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