Anticoagulants and Antiplatelets

Question 1

what dental procedures are unlikely to cause bleeding

Answer 1

LA
BPE
supragingival scaling
direct or indirect restorations
endodontics
impressions
fitting or adjusting ortho appliances

Question 2

what procedures have low risk of bleeding

Answer 2

simple extractions
incise and drain
6PPC
RSD
direct or indirect restorations with subgingival margins

Question 3

what are the high risk bleeding procedures

Answer 3

complex extractions
flap raising procedures
gingival contouring
biopsies

Question 4

why do chronic renal failure patients have high bleeding risk

Answer 4

platelet dysfunction

Question 5

why do liver disease patients have high bleeding risk

Answer 5

reduced production of coagulation factors
reduced platelet function and numbers

Question 6

why do haematological malignancy patients have increased bleeding risk

Answer 6

impaired coagulation or platelet function

Question 7

why do chemo and radiotherapy patients have high bleeding risk

Answer 7

pancytopenia - reduced platelet numbers

Question 8

what drug groups can cause a bleeding disorder

Answer 8

anticoagulants and antiplatelets
cytotoxic drugs
biologics
NSAIDs
drugs affecting nervous system

Question 9

how do you assess a patients bleeding risk

Answer 9

assess required dental treatment
ask about use of anticoagulant and antiplatelet drugs
ask about medical conditions that they have
ask about bleeding history

Question 10

what haemostatic measures should the dental practitioner have available

Answer 10

absorbent gauze
haemostatic packing material
suture kit

Question 11

if you are unsure about a patient’s bleeding risk who would you ask about it

Answer 11

haematologist and cardiologist
GMP

Question 12

what do you do if a patient is taking an anticoagulant and requires a treatment that is unlikely to cause bleeding

Answer 12

treat patient following standard procedures

Question 13

what do you do if a patient is taking an anticoagulant and needs a treatment that is likely to cause bleeding

Answer 13

delay if on limited time course of medication
consult prescribing clinician if it is needed
plan for early in day and early in week in case prolonged bleeding
provide with pre-treatment instructions
perform atraumatically
advise paracetamol not NSAID
provide post op instructions
dont interrupt regular medication

Question 14

what is the difference between warfarin and DOACs

Answer 14

warfarin cannot be stopped but DOACs can have their routine changed due to their rapid onset and short half life

Question 15

what are the recommendations for people on apixaban or dabigatran

Answer 15

miss morning dose

Question 16

what is the recommendations for people on rivaroxaban and edoxaban

Answer 16

delay morning dose

Question 17

if the patient takes rivaroxaban or edoxaban once and in the evening what do you do

Answer 17

they can take their dose normally as long as it is after 4 hours of treatment

Question 18

how do you monitor warfarin activity

Answer 18

INR

Question 19

what does an INR value of greater than 1 indicate

Answer 19

longer clotting time and longer bleeding time

Question 20

what is the INR value for a patient on warfarin that is okay to treat

Answer 20

4

Question 21

when should the patients INR be checked

Answer 21

no more than 24hrs before procedure

Question 22

what defines a stable INR

Answer 22

no INR measurements above 4 in the last 2 months

Question 23

if a patient has an INR above 4 but they need urgent dental care what do you do

Answer 23

refer to secondary dental care

Question 24

what do you do if a patient is taking an antiplatelet

Answer 24

continue with treatment as normal but be aware that prolonged bleeding may occur

Question 25

if a patient is taking a combination of anticoagulants and antiplatelets and needs treatment likely to cause bleeding what would you do

Answer 25

consult with prescribing clinician to see if a change in medication could be useful