anticoagulants and antiplatelets

Question 1

dental procedures with a high risk of post op bleeding complications

Answer 1

• complex extractions/ adjacent extractions that will cause a large wound or more than 3 extractions at once
• flap raising procedures
• biopsies
• gingival recontouring

Question 2

what patients should anticoagulant or antiplatelet therapy never be interrupted

Answer 2

• patients with prosthetic metal valves
• coronary stents
• pulmonary embolism or DVT in last 3 months
• patients on anticoagulant therapy for cardioversion

Question 3

advice for treating patients taking DOACs ( apixaban, rivaroxaban, dagibatran)

Answer 3

low risk of bleeding complications - no interruption to medication
high risk of bleeding - miss morning dose or delay daily dose if taken in morning

Question 4

advice for treating patients taking warfarin or other vit k antagonist (phenindione, acenocoumarol) for bleeding risk procedures

Answer 4

check INR ideally within 24 hours of appt, up to 72 hours if pt stable
if INR below 4, treat without interupting medication
if above 4, delay tx or refer if urgent

Question 5

what patients are at increased risk of developing infective endocarditis
(sub group for specific consideration)

Answer 5

• previous IE
• prosthetic valves
• congenital heart disease

Question 6

antibiotic prohylaxis for IE if required

Answer 6

amoxicillin, 3g 1 hour before procedure
OR if penicillin allergy
clindamycin 300mg 1 hour before procedure