Anticoagulants and Antiplatelet Drugs Flashcards

1
Q

if a patient is taking DOAC and requires a low risk dental procedure how should you treat them

A

treat without interrupting their anticoagulant medication and treat early in the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

if a patient is taking apixaban or dabigatran and requires a dental procedure with a higher risk of bleeding what should you tell them

A

miss their morning dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

if a patient is taking rivaroxaban or edoxaban and requires a high bleeding risk dental procedure what should you tell them

A

delay their morning dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the function of warfarin

A

a vitimin K agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how should you treat a patient who is taking warfarin with an INR below 4

A

treat without interrupting their anticoagulant medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

if a patient who is taking warfarin is going to undergo a dental treatment likely to cause bleeding what should you do

A

ensure the INR has been checked - ideally no more than 24 hours before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what should you do for a patient taking warfarin if their INR is above 4

A

delay treatment until the INR is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how should you treat a patient taking a prophylactic (low) dose of a low molecular weight heparin - injectable

A

treat without interrupting their anticoagulant medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the guidance for treating a patient on an antiplatelet drug

A

treat without interrupting their antiplatelet medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how long would you expect a patient taking an antiplatelet to bleed after a procedure

A

up to an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is involved in platelet formation

A

platelets become activated when there is damage to blood vessels causing them to adhere to one another and to the damaged blood vessel endothelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what type of haemostasis are platelets involved in

A

primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the action of coagulation

A

a cascade of reactions initiates that converts inactive coagulation factors to active forms which causes production of fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the action of fibrin

A

stabilises the primary platelet plug by cross linking the platelets to each other and to the damaged blood vessel wall to prevent further blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what type of haemostasis is coagulation

A

secondary haemostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do antiplatelet drugs work

A

interfere with platelet aggregation by reversibly or irreversibly inhibiting various steps in the platelet activation required for primary haemostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how do anticoagulants work

A

inhibit production or activity of the factors required for the coagulation cascade and impairs secondary haemostasis

18
Q

what medical conditions can predispose individuals for a risk of thrombosis

A

atherosclerosis and cardiac arrhythmias

19
Q

what dental procedures are low risk of post op bleeding complications

A

simple extractions
incision and drainage of intra-oral swellings
RSD
direct or indirect restorations with subgingival margins

20
Q

what dental procedures are higher risk of post operative bleeding complications

A

complex extractions
periodontal surgery
periradicular surgery
crown lengthening
dental implant surgery
biopsies
gingival contouring

21
Q

what medical disorders can put a patient at an increased bleeding risk

A

liver, kidney and bone marrow disorders

22
Q

why does chronic renal failure cause increased bleeding risk

A

associated platelet dysfunction

23
Q

why does liver disease increase bleeding risk

A

reduced production of coagulation factors, reduction in platelet number and function due to splenomegaly and alcohol excess can result in direct bone marrow toxicity

24
Q

why might recent or current chemotherapy or radiotherapy increase bleeding risk

A

pancytopenia including reduced platelet numbers

25
Q

give examples of inherited bleeding disorders

A

haemophilia and von Willebrands disease

26
Q

why might you need to be more careful with patients on dual, multiple or combined anticoagulants or antiplatelet therpaies

A

higher risk of bleeding complications

27
Q

why do you have to be careful treating patients on cytotoxic drugs

A

they are associated with bone marrow suppression which reduces platelet numbers and impairs liver function which impairs production of coagulation factos

28
Q

why do you have to be careful when treating patients that are taking biologic immunosuppression therapies

A

can cause thrombocytopenia and impair liver function

29
Q

why might you have to be careful treating patients on drugs affecting the nervous system like SSRIs or SNRIs

A

they have potential to impair platelet aggregation and may increase bleeding time in combination with other antiplatelet drugs

30
Q

what should the dental practitioner have on hand to deal with post operative bleeding complications

A

absorbent gauze
haemostatic packing material - collagen sponge
suture kit

31
Q

what pain relief should you advise patients who are at a high bleeding risk of taking

A

they should take paracetamol and avoid NSAIDs

32
Q

for what conditions should you not interrupt anticoagulant or antiplatelet therapy except when under written instruction from the cardiologist

A

patients with prosthetic metal heart valves or coronary stents
patients who have had pulmonary embolisms or DVT in the last 3 months
patients on anticoagulants for cardioversion

33
Q

what is the difference between warfarin and DOACs

A

DOACs have a rapid onset of action and relatively short half lives

34
Q

when should treatment be planned for a low risk bleeding procedure for a patient taking a DOAC

A

early in the day to allow for monitoring and management of bleeding complications should they occur
limit treatment area
use local haemostatic measures

35
Q

when should a missed morning dose of a DOAC be taken after dental treatment

A

4 hours after haemostasis has been achieved

36
Q

what INR value is equivalent to a patient not taking warfarin

A

1

37
Q

what are low molecular weight heparins

A

injectable anticoagulants

38
Q

why do patients taking antiplatelet medications at a higher risk of prolonged bleeding times

A

no platelet aggregation in the formation of initial platelet plug in primary haemostasis

39
Q

what is the most common antiplatelet combination

A

aspirin and clopidogrel

40
Q

what patients may be taking an antiplatelet and anticoagulant combination

A

atrial fibrillation and recent MI