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3rd yr- CSB- Oral surgery > Abnormal Bleeding > Flashcards

Abnormal Bleeding Flashcards

1
Q

Name some times you’ll experience patients bleeding in dentistry

A
  1. Tooth extraction
  2. Surgery
  3. Biopsies
  4. Trauma
  5. Periodontal therapy
  6. Pulpal exposure
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2
Q

Give some effects of blood loss

A
  1. Patient distress
  2. Blood in the tissues (bruising, infection)
  3. Blood in the stomach
  4. Blood in the airways
  5. Reduced oxygen flow
  6. Reduced protein and platelets
  7. Hypovolaemia
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3
Q

What is Hypovolaemia

A

Reduced blood flow

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4
Q

wHAT CAN Hypovolaemia lead to

A

Shock

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5
Q

How do we manage bleeding

A
  1. Be prepared
  2. Inform the patent before hand that they may bleed
  3. Check bleeding and clotting history
  4. Be as conservative as possible and dont plan multiple extractions in one visit
  5. Local measures
  6. Careful post op care and follow up
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6
Q

What local measures do we take to manage bleeding

A
  1. Pressure
  2. Suture
  3. Surgicel
  4. Patients
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7
Q

What is virchow’s triad

A

Describes 3 factors that important in valour formation:

1) blood flow
2) activation of blood coagulation
3) vein damage

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8
Q

What is Haemostasis

A

Prevention of blood loss

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9
Q

How is Haemostasis achieved

A
  1. Vascular spasm
  2. Platelet plug
  3. Blood coagulation
  4. Growth of fibrous tissue in the hole in the vessel permanently
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10
Q

What is vascular spasm

A

When smooth muscle in the blood vessel walls contacts and reduces blood loss

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11
Q

What is the aim of the vascular spasm

A

Prevents excessive blood floss in the body

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12
Q

How is a platelet plug formed

A
  1. Platelet adhere to exposed tissue collagen
  2. Platelets release thromboxane A2 which increases stickiness
  3. Platelet aggregation
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13
Q

What does aspirin do

A

It irreversibly binds to platelets and inactivates platelet COX

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14
Q

What is platelet COX

A

cyclooxygenase

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15
Q

What is the significance of cyclooxygenase

A

It is required for thromboxane A2 mediated aggregation

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16
Q

How does clopidogrel work

A

It binds to the P2Y12 receptor irreversibly and prevents Adenosine Di Phosphate (ADP) mediated aggregation

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17
Q

How long does it take for platelets renewed

A

about 10 days

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18
Q

How does Ibuprofen work

A

Ibuprofen binds to platelets reversibly

19
Q

How does platelet plug formation activate the coagulation cascade

A
  1. Tissue damage
  2. Exposure of sub endothelial collagen
  3. Platelet adhesion
  4. Enhances platelet adhesion and aggregation
  5. Enhanced activation of factor X and prothrombin
20
Q

Which patients are likely to be taking clopidogrel or aspirin?

A

Patients with:

  1. Vascular disease
  2. Ischaemic heart disease
  3. thromboembolic disease
  4. Stroke
  5. peripheral vascular disease
  6. In whom thrombi are more likely to form
21
Q

What is a thrombi

A

Platelet aggregations

22
Q

What affect does aspirin have on tooth socket bleeding time

A

Patients who take aspirin have a longer tooth socket bleeding time

23
Q

Should we tell patients taking aspirin to stop taking it before their extraction? Why?

A

NO:
Takes weeks for effect to be reversed
Risk of stopping is greater than risk of continuing

24
Q

List some tests we can take to test bleeding function

A
  1. INR (International normalised ratio)
  2. Platelet count
  3. APTT (Activated Partial Thromboplastin Time)
25
Q

Name the 2 pathways of the clotting cascading

A
  1. Intrinsic pathway

2. Extrinsic pathway

26
Q

What is the intrinsic pathway initiated by

A
  1. Exposed collage

2. Platelet activation

27
Q

What is the extrinsic pathway initiated by

A

Tissue damage

28
Q

What is the overall effect of the intrinsic and extrinsic pathway

A

They both meet together at the end and activate Prothrombin

This then activated thrombin which turns fibrinogen into fibrin

29
Q

What is the normal Platelet count

A

normal 200-400 *10^9/L

30
Q

A platelet count lower than what indicates a bleeding problem

A

lower than 100 *10^9/L

31
Q

Which bleeding test is the most commonly used

A

INR (especially in patents taking warfarin)

32
Q

Which patients are likely to be taking warfarin?

1

A

Patients with:

  1. Atrial fibrillation
  2. Heart valve abnormalities or replacement
  3. Thromboembolic disease
  4. ischaemic heart disease
33
Q

How does warfarin work

A

It prevents the action of vitamin K which prevents carboxylation of clotting factor precursors

34
Q

Why is vitamin K important in blood clotting

A

It is require by the liver to produce factors II, VII, IX and X

35
Q

What is the half life for clotting factors

A

60 hours

36
Q

When is the full impact of warfarin seen in a patient

A

About 7 days

37
Q

What are the disadvantage of warfarin

A
  1. Multiple drug interactions
  2. Difficult to get stable anti-coagulation
  3. Some food interactions
  4. Needs to be monitored
38
Q

Which drugs can warfarin interact with

A 
Metronidazole
Carbamazepine
Fluconazole
Miconazole
St Johns Wort
39
Q

What foods can warfarin interact with

A

Cranberry juice

40
Q

An INR below what is safe to do an extraction on

A

less than 4

41
Q

When should we check INR records of a patient

A

If stable, check INR 72hrs before extraction

If not check within 24hrs

42
Q

Give some advantages of new anticoagulants

A
  1. Single point of action
  2. Predictable effect
  3. No need for INR monitoring
  4. No interaction with food
43
Q

Give some disavantages of new anticoagulants

A

No antidote

Half life up to 17hrs

44
Q

How can we ask patients if they have any bleeding problems

A
  1. Do you have any problems with bleeding or bruising?
  2. Are you taking any medicines to thin the blood?
  3. Do you have any liver problems?

3rd yr- CSB- Oral surgery (4 decks)

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