5. Bleeding risk + haemorrage in OS patients Flashcards
What is haemorrhage?
What are the types of haemorrhage and when can they occur?
Haemorrhage = blood lost from a ruptured vessel
Haemostasis
What is haemostasis?
What are the types of haemostasis?
What are the stages of haemostasis?
What is coagulation?
What does coagulation occur through?
What is the coagulation cascade?
What are the different pathways?
Why is fibrinolysis
How is haemostasis controlled?
What happens if promotors of local haemostasis are overactive?
What happens if prevention of generalised thrombosis are overactive?
What are the causes of excessive over bleeding?
Abnormalities in blood vessels, platelets or coagulation
Blood vessel abnormalities
What are examples of inherited blood vessel abnormalities?
What are examples of acquired blood vessel abnormalities?
What is thrombocytopenia?
Thrombocytopenia = decrease in number of platelet count
What is the normal range of platelets?
Normal range = 150-400x 10^9/l
What is the minimum number of platelets needed for dental extraction?
50 x 10^9 / l
What is the minimum number of platelets needed for LA infiltration
30 x 10^9 / l
Abnormal platelets / platelet defects
What are examples of inherited platelet defects?
What are examples of acquired platelet defects?
Antiplatelet therapy
How does it work?
What is it used for?
Action?
Antiplatelet therapy
What is traditional Antiplatelet therapy and examples?
Antiplatelet therapy
What is new Antiplatelet therapy and examples?
Antiplatelet therapy
What is dual antiplatelet therapy?
What are other drugs that can affect platelets?
Can an Extraction be done with antiplatelet drugs ?
What is Coagulopathy
Coagulopathy - Clotting of the blood is impaired = bleeding
Coagulation Disorders
Examples of inherited coagulation disorders?
Examples of acquired coagulation disorders?
What are the different anti coagulants dentists encounter
Warfarin
DOACS
Heparin/Clexane (injectable)
Warfarin
Action?
Onset?
Monitoring?
Reversible?
Interactions?
Use?
DOACS
Action?
Onset?
Monitoring?
Reversible?
Interactions?
Use?
Heparin/Clexane
Action?
Onset?
Monitoring?
Reversible?
Interactions?
Use?
What are examples of DOAC drugs?
Dabigatran
RivaroXaban
ApiXaban
EdoXaban
How do DOAC drugs affect the coagulation cascade?
Extraction on DOACs
Can Extraction be done on warfarin?
Extraction on DOACs
What are the rules for extractions for other common doacs?
Extraction on DOACs
Extraction when taking combination anticoagulants?
How can we assess risk or likelihood of a patient bleeding following oral surgery intervention
What do you do for extraction in a low risk patient for bleeding?
What do you do for extraction in a high risk patient for bleeding?
Management of a bleeding patient?
Is it different for the different types of bleeding?
Management of a bleeding patient using local haemostatic measures is as follows:
What are the practical steps on achieving haemostatic control?
DIAGRAM 3 EXTRA
- ensure gauze pack is moist using saline to prevent blood clot being pulled out when gauze pack is removed
- soaking packet in tranexamic acid solution can help to further promote haemostasis
What is tranexamic acid?
What is tranexamic acid used for?
What happens if attempt to stop bleeding are:
Successful?
Unsuccessful ?
What does management of all medically complex patients involves :
