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SDCEP > anticoagulants and antiplatelets > Flashcards

anticoagulants and antiplatelets Flashcards

1
Q

how would you treat a patient taking anticoagulants or anti-platelets requires dental treatment that is unlikely to cause bleeding?

A

standard procedure - care to avoid bleeding

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2
Q

how would you treat a patient taking anticoagulants or anti-platelets requires dental treatment that is likely to cause bleeding?

A

if medication is time limited delay non-urgent invasive treatment
consult with pt clinician
plan treatment for early in day and week
only discharge when achieve haemostasis
advise paracetamol for pain relief
pre and post treatment advice

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3
Q

which patients should you not interrupt anticoagulant or anti-platelet therapy?

A

prosthetic heart valve/coronary stent
pulmonary embolism or DVT in last 3 months
cardioversion

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4
Q

for a patient taking a daily oral anticoagulant DOAC explain how you would treat for low risk bleeding procedure

A

treat according to advice
treat without interrupting medication
treat early in day
limit initial treatment area
consider suture and packing

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5
Q

for a patient taking daily oral anticoagulant DOAC apixaban or dabigatran explain how you would treat for higher risk bleeding procedure

A

miss morning dose of apixaban or dabigatran
treat early in day and according to advice
suture and packing
advice when torestart meds

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6
Q

for a patient taking daily oral anticoagulant DOAC rivaroxaban or edixaban explain how you would treat for higher risk bleeding procedure

A

delay rivaroxaban or edixaban delay RElay
treat early in day and according to advice
suture and packing
advice when torestart meds

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7
Q

how should you treat a patient taking warfarin or another vitamin K antagonist with an INR below four

A

treat without interrupting their anticoagulant medication

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8
Q

when should INR be checked before treatment?

A

ideally no more than 24hrs before but if their INR is stable up to 72hrs is acceptable

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9
Q

what do you do if pt INR is greater than or equal to 4?

A

inform pt anticoagulation service or GP
delay invasive dental treatment until INR reduced
if treatment urgent - refer to secondary dental care

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10
Q

how should you treat a patient with an INR less than 4?

A

treat according to general advice for managing bleeding risk

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11
Q

for all warfarin patients, how should you plan treatment and manage post op.

A

consider limiting initial treatment
stage treatment
suture and pack

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12
Q

how do you treat a patient taking prophylactic low dose of low molecular weight heparin?

A

treat without interrupting medication

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13
Q

what do you do if you are unsure if patient is taking prophylactic - low or treatment - high dose of heparin OR if patient is taking high dose heparin?

A

consult with clinician prescribing

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14
Q

should you interrupt antiplatelet therapy in patients taking single or dual anti platelet drugs?

A

no - treat with general advice for managing bleeding risk

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15
Q

how should you plan to treat a patient taking aspirin ?

A

consider limiting initial treatment area
treat in staged manner for higher risk bleeding
use local haemostatic measures to achieve haemostasis
be aware bleeding may be prolonged

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16
Q

when a patient takes anticoagulant and anti platelet combined, what should you do for either high or low risk procedure?

A

consult prescribing physician top assess impact of drugs and medical condition on bleeding risk

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17
Q

what should you always be cautious of when prescribing to a patient on anticoagulants/antiplatelets?

A

drug interactions

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18
Q

give two examples of anti platelet drugs?

A

clopidogrel
aspirin

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19
Q

give two examples of DOAC

A

apixaban
dabigatran

20
Q

what do anticoagulants and antiplatelets do?

A

reduce the ability of blood to form clots, or
coagulate

21
Q

summarise the coagulation cascade

A

1 damage to blood vessels activates platelets locally
2 platelets adhere to eachother and endothelium
3 coagulation factors activated and lead to fibrin protein production
4 fibrin stabilises primary platelet plug bu cross-linking platelets each other and endothelium

22
Q

what is primary haemostasis?

A

when platelets adhere to eachother and endothelium

23
Q

what is the activated cross-linking form of fibrinogen

A

fibrin

24
Q

what is secondary haemostasis

A

fibrin stabilises primary platelet plug by cross-linking platelets each other and endothelium

25
Q

give two examples of patients at risk of thrombosis?

A

cardiac arrhythmia
atherosclerosis

26
Q

what is a thromboembolism?

A

when a blood clot travels to a different critical site from where it was formed

27
Q

what is the mode of action of warfarin?

A

inhibits vitamin k dependent modification of prothrombin

28
Q

what do apixaban, rivaroxaban and edoxaban inhibit?

A

factor 10a

29
Q

what does dabigatran inhibit?

A

thrombin

30
Q

what is involved ion assessing bleeding risk - 2 things

A

patients individual level of bleeding risk
risk of bleeding associated with procedure

31
Q

give 3 examples of unlikely to cause bleeding procedure

A

BPE
LA
impressions

32
Q

give 3 examples of low risk bleeding procedure

A

simple extractions - 1-3 teeth
6PPC
RSD

33
Q

give 3 examples of high risk bleeding complications

A

complex extractions e.g. 8s or >3 teeth
flap raising procedure e.g. periodontal surgery
biopsies

34
Q

what medical conditions are associate with increased bleeding risk?

A

liver kidney and bone marrow disorders
liver disease
chronic renal failure
haematological malignancy

35
Q

what is pancytopenia

A

deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

36
Q

give 3 drug categories affecting bleeding risk

A

anticoagulants
anti platelet - can be non- prescribed aspirin
NSAIDs- affect platelet function

37
Q

give an example of herbal medicine affecting bleeding risk

A

st johns wort

38
Q

give three questions to ask when assessing bleeding risk

A

anticoagulant or antiplatelets

if treatment is limited or for lifetime - could delay

bleeding history - previous experience

39
Q

what are the 4 components of suturing kit

A

needle holders
tissue forceps
scissors
suture material

40
Q

why plan treatment for pt at increased bleeding risk early in day and week

A

to allow time for the
management of prolonged bleeding or rebleeding episodes, should they occur.

41
Q

what should you advise for pain relief for pt with bleeding risk

A

paracetamol

42
Q

what drug interactions increase bleeding risk for most antiplatelets and anticoagulants

A

NSAIDS - ibuprofen and aspirin

43
Q

what drug will reduce anticoagulant effect of most anticoagulants

A

carbamazepine

44
Q

give 3 indications for anticoagulant or anti platelet therapy

A

DVT or pulmonary embolism
prosthetic replacement heart valve
coronary stent

45
Q

why does missing or delaying DOAC dose significantly reduce the level of anticoagulation and what minimises the period low anticoagulation levels?

A

due to short half lives of DOAC
rapid onset of action of DOAC

46
Q

how long should patient taking DOAC wait after haemostasis is achieved before taking their next dose?

A

at least 4 hrs

47
Q

how do you limit initial treatment area?

A

perform a single extraction or limit root
surface debridement to three teeth, then assess bleeding before continuing

SDCEP (8 decks)

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