anticoagluation for dentists - haematological diseases

Question 1

thrombosis

Answer 1

inappropriate blood coagulation within a vessel

Question 2

types of thrombosis

Answer 2

arterial circulaton

venos cirulation

Question 3

arterial circulation features

Answer 3

• high pressure system
• platelet rich
• treated with antiplatelet drugs

Question 4

venous circulation features

Answer 4

• low pressure system
• fibrin rich
• treatment with anticoagulant drugs

Question 5

anti platelet drugs

Answer 5

aspirin
clopidogrel
prasugrel

Question 6

asparin

Answer 6

• inhibits cyclo-oxygenase (platelet enzyme) irreversible

- acts for a lifetime of platelet i.e. 7-10 days

Question 7

clopidogrel

Answer 7

• blocks ADP receptor on platelet surface irreversibly

- acts for lifetime of platelet

Question 8

prasugrel

Answer 8

• blocks ADP receptor irreversibly

- acts for a lifetime of platelet i.e. 7-10 days

Question 9

anticoagulants and their types

Answer 9

1) IV
- unfractionated heparin
2) subcutaneous
- low molecular weight heparins eg enoxaparin, tinzaparin, dalteparin
3) oral
- warfarin
- dabigatran
- rivaroxaban
- apixaban
- edoxaban

Question 10

heparin

Answer 10

binds to antithrombin and increases activity (inhibits coagulation cascade)
indirect thrombin inhibitor

Question 11

how to monitor heparin

Answer 11

APTT test

Question 12

what does warfarin do

Answer 12

inhibits production of
factor II, VII,IX, X
protein C and s

Question 13

interactions of warfarin

Answer 13

potentiation of anticoagulation

inhibition of anti-coagluation

Question 14

how to monitor warfarin

Answer 14

INR

Question 15

side effects of warfarin

Answer 15

bleeding
skin necrosis
embryopathy

Question 16

how to reverse warfarin

Answer 16

stop warfarin (2-3 day)
vit K (6 hrs)
fresh frozen plasma
clotting fator concentrate (10 min)

Question 17

when is it safe to perform extractions on warfarin

Answer 17

provided INR is less than 4

all its must have INF 24 hours or less

Question 18

non warfarin oral anticoalglants

Answer 18

NOACs

DOACs

Question 19

NOACs

Answer 19

rivaroxaban 
apixban
edoxaban
Xa inhibitor
Dibigatrn (thrombin inhibitor)

Question 20

DOACs

Answer 20

for treatment of thombosis
aims to replace warfarin
no monitoring
no alcohol or food interactions
half life 6-15 hrs
no antidote

Question 21

DOACs and dental surgery extraciton procedures, when to take dose

Answer 21

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