Anticoagulants or Antiplatelet Drugs Flashcards
When should you not interrupt anticoagulant or antiplatelet therapy?
SDCEP
- patients with prosthetic metal heart valves or coronary stents
- patients who have had a pulmonary embolism or deep vein thrombosis in the last three months
- patients on anticoagulant therapy for cardioversion
What is the general advice (guidance) for all patients taking anticoagulants/antiplatelet drugs requiring dental treatment likely to cause bleeding?
SDCEP
- plan treatmet early in the day and week
- provide pre-treatment instructions
- treat atraumatically, use appropriate local measures and only discharge once haemostasis has been achieved
- if travel time to emergency care is a concern, place emphasis on the use of measures to avoid complications
- provide patient with post-treatment advice and emergency conntact details
What dental procedures have a low risk of post-operative bleeding complications?
procedures are likely to cause bleeding
- simple extractions (1-3 teeth, with restricted wound size)
- incision and drainage of intra-oral swellings
- detailed 6PPC
- root surface debridement (RSD)
- direct or indirect restorations with subgingival margins
What dental procedures have a high risk of post-operative bleeding complications?
procedures are likely to cause bleeding
- complex extractions, adjacent extractions that will cause a large wound or more than 3 extractions at once
- flap raising procedures including elective surgical extractions, periodontal surgery, preprosthetic surgery, periradicular surgery, crown lengthening, dental implant surgery
- gingival recontouring
- biopsies
What are examples of Direct Oral Anticoagulants (DOACs)?
apixaban
dabigatran
rivaroxaban
edoxaban
What is the guidance for patients taking DOACs for low bleeding risk procedures?
SDCEP
- treat without interrupting medication
- treat early in the day
- limit initial treatment area and assess bleeding before continuing
- consider staginng extensive or complex procedures
- strongly consider suturing and packing
What is the guidance for patients taking DOACs for high bleeding risk procedures?
SDCEP
- Advise patient to miss/delay morning dose before treatment:
Apixaban/Dabigatran (usual 2 doses): miss morning dose; usual time in evening
Rivaroxaban/Edoxaban (usual 1 dose): delay morning dose; 4 hours after haemostasis has been achieved - treat early in the day
- limit initial treatment area and assess bleeding before continuing
- consider staginng extensive or complex procedures
- strongly consider suturing and packing
- advise patient when to restart their medication
What are examples of Vitamin K Antagonist?
(3)
warfarin
acenocoumarol
phenindione
What is the guidance for patients taking vitamin K antagonist for dental procedures likely to cause bleeding?
SDCEP
- check INR no more than 24h before procedure (up to 72h if patient has stable INR)
- INR < 4: treat without interrupting medication
- INR ≥ 4: delay invasive treatment or refer if urgent
- consider limiting initial treatment area
- consider staging extensive or complex procedures
- strongly consider suturing and packing
What is the guidance for patients taking inectable anticoagulant for dental procedures likely to cause bleeding?
SDCEP
- Prophylactic (low) dose: treat without interrupting
- Treatment (higher) dose or uncertainty about the dose: consult with prescribing clinician for more info
- connsider limiting initital treatmet area
- consider staging extensive or complex procedures
- strongly consider suturing and packing
What are examples of injectable anticoagulants?
SDCEP
dalteparin
enoxaparin
tinzaparin
What are examples of antiplatelet drugs?
SDCEP
aspirin
clopidogrel
dipyridamole
prasugrel
ticagrelor
What is the guidance for patients taking aspirin for dental procedures likely to cause bleeding?
- treat without interrupting medication
- consider limiting initial treatment area
- consider staging extensive or complex procedures
- use local haemostatic measures
What is the guidance for patients taking antiplatelet drugs for dental procedures likely to cause bleeding? (clopidogrel, dipyridamole, prasugrel, ticagrelor)
SDCEP
- treat without interrupting medication
- expect prolonged bleeding
- limit initial treatment area
- consider staging extensive or complex procedures
- strongly consider suturing and packing
