Anti-coagulation In Dentistry

Question 1

What are anti-coagulants and anti-platelets prescribed for

Answer 1

To reduce the risk of a thrombosis with potential for a MI, pulmonary embolism or stroke in patients who suffer certain medical conditions

Question 2

What medical conditions could a patient taking anti-coagulants or anti-platelets suffer from

Answer 2

Vascular or thromboembolic conditions 
Cardiac conditions 
History of stroke
Following heart valve replacement
Cardiac stents 
Joint replacements

Question 3

What do anti-coagulants increase the risk of

Answer 3

Bleeding - spontaneous or associated with invasive procedures

Question 4

What are the 3 most common anti-coagulant treatments

Answer 4

Vitamin K antagonists - Warfarin
Anti-platelets
Novel oral anti-coagulants (NOAC)

Question 5

How does warfarin inhibit coagulation

Answer 5

By antagonizing vitamin K

Question 6

How long does it take for the anti-coagulation effects to develop

Answer 6

48-72 hours

Question 7

What does INR stand for

Answer 7

International Normalised Ratio

Question 8

What is the INR testing

Answer 8

Prothrombin time

Question 9

What is the normal IRN

Answer 9

1

Question 10

If an INR is >1 what does it indicate

Answer 10

Clotting time will be longer

Question 11

What should you do it the INR is >4

Answer 11

Inform GMP and delay treatment

Question 12

What should you do if the INR is >4 but the pt requires emergency treatment

Answer 12

Ref to secondary dental care

Question 13

Is there evidence to suggest that an IDB performed on an anti-coagulant patient poses a risk of bleeding

Answer 13

No

Question 14

Why should you try to see patients on anti-coagulants early in the day

Answer 14

Lower BP

Question 15

Why should you try to see patients on anti-coagulants early in the week

Answer 15

If any problems arise you have the rest of the week to deal with it

Question 16

What pain relief should you not advise for anti-coagulant patients

Answer 16

Asprin or NSAIDs

Question 17

When should you get advise from the patients GMP

Answer 17

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

Question 18

What 6 things can increase the activity of warfarin

Answer 18

Anti bacterials
Anti epileptics
Anti fungals
Hormones
Cardiac drugs
Analgesics

Question 19

What 5 things can decrease the activity of warfarin

Answer 19

Anti epileptics
Anti fungals
Cardiac drugs
Analgesics
Other meds

Question 20

What other things could influence the effects of warfarin

Answer 20

Irregular tablet taking
Diet high in vitamin k
Alcohol
Cranberry juice

Question 21

What are the two most common anti platelets

Answer 21

Asprin

Clopidogrel

Question 22

What would asprin be prescribed for

Answer 22

Prophylaxis of cerebrovascular disease or MI

Question 23

Name a Novel oral anti-coagulants

Answer 23

Rivaroxaban

Question 24

What is Rivaroxaban used for

Answer 24

Prophylaxis of venous thromboembolism in adults after hip/knee replacement

Question 25

What is the advantage of Novel oral anti-coagulants

Answer 25

Do not require anti-coagulant monitoring