Mgmt of Patients on Blood Thinners Flashcards
Management of Dental Patients Receiving Blood Thinners
(Antiplatelet and Anticoagulant therapy)
* There is a large number of patients who currently take Oral anticoagulants like (Warfarin,
Pradexa etc.,) or Antiplatelet Medications (Plavix, Aspirin) for various medical conditions.
These patients are at higher risk of — during oral surgical procedures.
* Therefore, as dentists it is important to be knowledgeable of the different type of antiplatelet
and anticoagulants commonly used by the patients.
* In this presentation, we will review the classes of drugs (blood thinners), facts about their half
life and also the mechanism of action.
hemorrhage
Patient’s on Oral anticoagulant/antiplatelet treatment are currently not recommended to
discontinue their medication prior to minor oral surgery procedures as this increases their risk
of developing a
thrombo-embolic episode
Patient’s on Oral anticoagulant/antiplatelet treatment are currently not recommended to
discontinue their medication prior to minor oral surgery procedures as this increases their risk
of developing a thrombo-embolic episode.
* In these patients, we currently recommend using – measures to control bleeding after
surgery.
local
Patient’s on Oral anticoagulant/antiplatelet treatment are currently not recommended to
discontinue their medication prior to minor oral surgery procedures as this increases their risk
of developing a thrombo-embolic episode.
* In these patients, we currently recommend using local measures to control bleeding after
surgery.
* However, If patient’s need major oral surgery procedures, then appropriate
* It is important to understand the fact that the decision to withhold the antiplatelet/anticoagulant
medication can only be made by the physician and not the treating dentist.
medical
consultation with physician is sought and the anticoagulant/antiplatelet medication is withheld
from patient a few day/days prior to surgery.
Aspirin - Cyclooxygenase inhibitors
Aspirin, an acetylated salicylate (acetylsalicylic acid), is classified among the —
These agents reduce the signs and symptoms of — and exhibit a broad range of
pharmacologic activities, including (3) properties.
nonsteroidal
antiinflammatory drugs (NSAIDs).
inflammation
analgesic, antipyretic, and antiplatelet
Aspirin
Antiplatelet drugs: Cyclooxygenase inhibitors
* Aspirin — inactivates cyclooxygenase
* Platelets cannot synthesize protein, so cannot make — until new platelets
are made
* The lack of thromboxane markedly diminishes (2)
* OTHER NSAIDs ARE NOT —!!!!
* They inhibit cyclooxygenase but are effective only while drug is present
irreversibly
thromboxane
platelet activation and aggregation
IRREVERSIBLE
Aspirin – Mechanism of Action
Effect of dose — Aspirin’s effects and respective mechanisms of action vary with dose:
●Low doses (typically 81 mg/day) are
●Intermediate doses (650 mg to 4 g/day)
sufficient to irreversibly acetylate serine 530 of cyclooxygenase (COX)-1. This
effect inhibits platelet generation of thromboxane A2, resulting in an antithrombotic effect.
inhibit COX-1 and COX-2, blocking prostaglandin (PG) production, and have
analgesic and antipyretic effects.
Indications for low dose Aspirin treatment
* LOW DOSE —
* At low dose, very minimal chance of —
* Decreases incidence of MI by –%
- But it’s (2)
Prophylaxis
GI bleeding
2
cheap and safe
- LOW DOSE Prophylaxis
(2)
- One children’s aspirin/day or 81 mg
- More doesn’t work and can be harmful
Plavix (Clopidogrel Bisulfate)
* Clopidogrel is used to
* Clopidogrel works by
prevent M.I and Cerebro-vascular accidents in persons with cardiac
disease(recent M.I), recent stroke or those with peripheral vascular disease.
blocking platelets from sticking together and prevents them from forming
harmful clots.
Who receives oral anticoagulants ?
* Anticoagulation therapy is used in several conditions to prevent or treat
—
thromboembolism
The patients with the following medical conditions take oral anticoagulants.
(6)
- Prosthetic heart valves
- Atrial fibrillation
- Valvular heart disease
- Previous deep vein thrombosis
- Pulmonary embolism
- Congestive cardiomyopathy
What is the method of action of Warfarin Sodium ?
* Warfarin is a — antagonist.
* It affects clotting factors (4) and makes them biologically inactive.
* It affects factor — first and this increases the —
* It then affects factors (3) and thereby increases the —
vitamin K
II, VII, IX, X
VII
prothrombin time (PT).
IX, X and II
partial thromboplastin time (PTT) .
Lab Tests For Patients Receiving Coumadin (Warfarin Sodium)
* Patients who receive Warfarin require frequent —
* The coagulation status of a patient taking Warfarin assessed with an —
* The INR (International Normalized Ratio) is a standardized —
lab monitoring.
International
Normalized Ratio (INR) test.
prothrombin time test.
Significance of the INR test
* The INR was developed to normalize the
PT test based on the sensitivity of different
thromboplastins and is calculated as shown below
