anticoagulants and antiplatelets

Question 1

name 3 dental procedures
- unlikely to cause bleeding
- likely to cause bleeding but low risk of post op bleeding complications
- high risk of post op bleeding complications

Answer 1

• BPE, supragingival scaling, restorations with supragingival margins
• simple extractions (1-3 teeth), restorations with subgingival margins, 6PPC
• biopsy, flap raising procedure, complex extractions or >3 at once

Question 2

name 3 examples of DOACs
(direct oral anticoagulants)

Answer 2

dabigatran
apixaban
rivaroxaban
edoxaban

Question 3

what should the patient be advised about their DOAC medications before a procedure that has a high risk of post op bleeding complications

Answer 3

either miss (dabigatran/apixaban) or delay (rivaroxaban, edoxaban) their morning dose at least 4 hours post haemostasis

• dabigatran and apixaban usually taken twice a day
• edoxaban and rivaroxaban usually taken once a day, if taken in evening no change to schedule required

Question 4

discuss warfarin and INR with regards to an invasive procedure

Answer 4

patients taking warfarin should have INR checked ideally within 24 hours of procedure (up to 72 if stable long term)
If INR <4 treat with no change to medications
If INR >4 delay tx or refer if in an emergency

Question 5

discuss treatment for a patient taking aspirin alone

Answer 5

treat without interrupting medications
use haemostatic measures and carry out treatment in a staged manner

Question 6

treatment of patients taking a singular or dual anti platelet

Answer 6

treat without interupting medication but expect prolonged bleeding and emply local haemostatic measures