anticoagluation for dentists - haematological diseases Flashcards
thrombosis
inappropriate blood coagulation within a vessel
types of thrombosis
arterial circulaton
venos cirulation
arterial circulation features
- high pressure system
- platelet rich
- treated with antiplatelet drugs
venous circulation features
- low pressure system
- fibrin rich
- treatment with anticoagulant drugs
anti platelet drugs
aspirin
clopidogrel
prasugrel
asparin
- inhibits cyclo-oxygenase (platelet enzyme) irreversible
- acts for a lifetime of platelet i.e. 7-10 days
clopidogrel
- blocks ADP receptor on platelet surface irreversibly
- acts for lifetime of platelet
prasugrel
- blocks ADP receptor irreversibly
- acts for a lifetime of platelet i.e. 7-10 days
anticoagulants and their types
1) IV
- unfractionated heparin
2) subcutaneous
- low molecular weight heparins eg enoxaparin, tinzaparin, dalteparin
3) oral
- warfarin
- dabigatran
- rivaroxaban
- apixaban
- edoxaban
heparin
binds to antithrombin and increases activity (inhibits coagulation cascade)
indirect thrombin inhibitor
how to monitor heparin
APTT test
what does warfarin do
inhibits production of
factor II, VII,IX, X
protein C and s
interactions of warfarin
potentiation of anticoagulation
inhibition of anti-coagluation
how to monitor warfarin
INR
side effects of warfarin
bleeding
skin necrosis
embryopathy
how to reverse warfarin
stop warfarin (2-3 day)
vit K (6 hrs)
fresh frozen plasma
clotting fator concentrate (10 min)
when is it safe to perform extractions on warfarin
provided INR is less than 4
all its must have INF 24 hours or less
non warfarin oral anticoalglants
NOACs
DOACs
NOACs
rivaroxaban apixban edoxaban Xa inhibitor Dibigatrn (thrombin inhibitor)
DOACs
for treatment of thombosis aims to replace warfarin no monitoring no alcohol or food interactions half life 6-15 hrs no antidote
DOACs and dental surgery extraciton procedures, when to take dose
apixaban or dibaigran
- twice a day
- miss morning dose
Post treatment, usual time in evening
rivaoxaban
once day morning
- delay morneing
Post - 4hrs after haemostats has been achieved
edoxaban
-evening 1x day
post
- usual time in the evening
