Anticoagulants & Antiplatelets Flashcards
What are dental procedures that are unlikely to casue bleeding?
- LA infiltration & IDB
- BPE
- supragingival removal of plaque, calculus and staining
- direct or indirect restorations with supragingival margins
- endodontics
- impressions/pros procedures
- fitting & adjustment of ortho appliances
What are dental procedures that are likely to cause bleeding on a low risk scale?
- simple extractions (1-3 teeth)
- incision and drainage of intraoral swellings
- detailed 6PPC
- root surface debridement
- direct/indirect restorations with subgingival margins
What are dental procedures that are likely to cause bleeding on a high risk scale?
- complex extractions
- flap raising procedures (surgical extractions, periodontal surgery, periradicular surgery, crown lengthening, dental implant surgery
- biopsy
- gingival recontouring
Why do patients suffering from chronic renal failure have an increased bleeding risk?
associated platelet disfunction
Why do patients suffering from liver disease have an increased bleeding risk?
- reduced production of coagulation factors
- reduction in platelet number & function
- alcohol excess can also result in direct bone marrow toxicity and reduced platelet numbers
Why do patients who have has recent or current chemotherapy or radiotherapy have an increased bleeding risk?
Pancytopenia including reduced platelet numbers
How should you assess bleeding risk in a clinical scenario?
- is dental treatment required high bleeding risk
- confirm medication & use with patient
- find out if anticoag/antiplatelet treatment is lifelong or limited
- ask patient about medical conditions
- ask patient about bleeding history
What haemostatic measures may be required in anticoagulant / antiplatelet patients after a dental procedure that causes bleeding?
- suturing
- haemostatic packing material eg oxidized cellulose or collagen sponge
- absorbent gauze
If a patient is on a time-limited course of anticoagulant/antiplatelet medication and they need extractions what should be done?
Delay non-urgent, invasive dental procedures where possible
What analgesia would you advise a pateint currently taking anticoagulant/antiplatelet medication to take?
Paracetamol
How do DOACs compare to warfarin?
DOACs have a rapid onset of action and a shorter half life
What is the half life of Apixaban?
12 hours
A patient is taking a DOAC drug and requires dental treatment that has a low risk of bleeding complications, what would you do?
treat without interrupting anticoagulant medication
A patient is taking a DOAC drug and requires dental treatment that has a high risk of bleeding complications, what would you do?
If apixaban/dabigatran = miss morning dose on day of treatment
Rivaroxaban/edoxaban = delay morning dose on day of treatment
In addition to dose delaying/skipping, what else should be arranged when performing high bleeding risk procedures on DOAC patients?
- plan treatment early in day to allow for monitoring/managine any bleeding complications
- consider carrying out treatments in staged manner over separate visits
- strongly consider suturing and packing
