Anti-coagulation In Dentistry Flashcards
What are anti-coagulants and anti-platelets prescribed for
To reduce the risk of a thrombosis with potential for a MI, pulmonary embolism or stroke in patients who suffer certain medical conditions
What medical conditions could a patient taking anti-coagulants or anti-platelets suffer from
Vascular or thromboembolic conditions Cardiac conditions History of stroke Following heart valve replacement Cardiac stents Joint replacements
What do anti-coagulants increase the risk of
Bleeding - spontaneous or associated with invasive procedures
What are the 3 most common anti-coagulant treatments
Vitamin K antagonists - Warfarin
Anti-platelets
Novel oral anti-coagulants (NOAC)
How does warfarin inhibit coagulation
By antagonizing vitamin K
How long does it take for the anti-coagulation effects to develop
48-72 hours
What does INR stand for
International Normalised Ratio
What is the INR testing
Prothrombin time
What is the normal IRN
1
If an INR is >1 what does it indicate
Clotting time will be longer
What should you do it the INR is >4
Inform GMP and delay treatment
What should you do if the INR is >4 but the pt requires emergency treatment
Ref to secondary dental care
Is there evidence to suggest that an IDB performed on an anti-coagulant patient poses a risk of bleeding
No
Why should you try to see patients on anti-coagulants early in the day
Lower BP
Why should you try to see patients on anti-coagulants early in the week
If any problems arise you have the rest of the week to deal with it
What pain relief should you not advise for anti-coagulant patients
Asprin or NSAIDs
When should you get advise from the patients GMP
If there INR is unstableor >4 in the last 2 months
Other disorders of haemostasis
Renal failure, liver disease or alcoholism
Pt receiving cytotoxic drugs or radiotherapy
What 6 things can increase the activity of warfarin
Anti bacterials Anti epileptics Anti fungals Hormones Cardiac drugs Analgesics
What 5 things can decrease the activity of warfarin
Anti epileptics Anti fungals Cardiac drugs Analgesics Other meds
What other things could influence the effects of warfarin
Irregular tablet taking
Diet high in vitamin k
Alcohol
Cranberry juice
What are the two most common anti platelets
Asprin
Clopidogrel
What would asprin be prescribed for
Prophylaxis of cerebrovascular disease or MI
Name a Novel oral anti-coagulants
Rivaroxaban
What is Rivaroxaban used for
Prophylaxis of venous thromboembolism in adults after hip/knee replacement
What is the advantage of Novel oral anti-coagulants
Do not require anti-coagulant monitoring
