Anticoagulants and Antiplatelets Flashcards
what dental procedures are unlikely to cause bleeding
LA
BPE
supragingival scaling
direct or indirect restorations
endodontics
impressions
fitting or adjusting ortho appliances
what procedures have low risk of bleeding
simple extractions
incise and drain
6PPC
RSD
direct or indirect restorations with subgingival margins
what are the high risk bleeding procedures
complex extractions
flap raising procedures
gingival contouring
biopsies
why do chronic renal failure patients have high bleeding risk
platelet dysfunction
why do liver disease patients have high bleeding risk
reduced production of coagulation factors
reduced platelet function and numbers
why do haematological malignancy patients have increased bleeding risk
impaired coagulation or platelet function
why do chemo and radiotherapy patients have high bleeding risk
pancytopenia - reduced platelet numbers
what drug groups can cause a bleeding disorder
anticoagulants and antiplatelets
cytotoxic drugs
biologics
NSAIDs
drugs affecting nervous system
how do you assess a patients bleeding risk
assess required dental treatment
ask about use of anticoagulant and antiplatelet drugs
ask about medical conditions that they have
ask about bleeding history
what haemostatic measures should the dental practitioner have available
absorbent gauze
haemostatic packing material
suture kit
if you are unsure about a patient’s bleeding risk who would you ask about it
haematologist and cardiologist
GMP
what do you do if a patient is taking an anticoagulant and requires a treatment that is unlikely to cause bleeding
treat patient following standard procedures
what do you do if a patient is taking an anticoagulant and needs a treatment that is likely to cause bleeding
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
what is the difference between warfarin and DOACs
warfarin cannot be stopped but DOACs can have their routine changed due to their rapid onset and short half life
what are the recommendations for people on apixaban or dabigatran
miss morning dose
what is the recommendations for people on rivaroxaban and edoxaban
delay morning dose
if the patient takes rivaroxaban or edoxaban once and in the evening what do you do
they can take their dose normally as long as it is after 4 hours of treatment
how do you monitor warfarin activity
INR
what does an INR value of greater than 1 indicate
longer clotting time and longer bleeding time
what is the INR value for a patient on warfarin that is okay to treat
4
when should the patients INR be checked
no more than 24hrs before procedure
what defines a stable INR
no INR measurements above 4 in the last 2 months
if a patient has an INR above 4 but they need urgent dental care what do you do
refer to secondary dental care
what do you do if a patient is taking an antiplatelet
continue with treatment as normal but be aware that prolonged bleeding may occur
if a patient is taking a combination of anticoagulants and antiplatelets and needs treatment likely to cause bleeding what would you do
consult with prescribing clinician to see if a change in medication could be useful
