Anticoagulants SDCEP

Question 1

Examples of Direct oral anticoagulants

Answer 1

Apixaban, Dabigatran, rivaroxaban, edoxban

Question 2

Examples of vit K antagonists

Answer 2

warfarin

Question 3

Examples of injectable anticoagulants

Answer 3

dalteparin, enoxaparin, tinzaparin

Question 4

examples of antiplatlets

Answer 4

• aspirin
• clopidogrel
• dipyridamole

Question 5

if the dental treatmet is unlikely to cause bleeding how do you manage pt on anticoagulants

Answer 5

treat with caution using standard procedures, taking care to avoid causing bleeding

Question 6

if dental tx is likely to cause bleeding and medication is time limited how do you manage pt on anticoagulants

Answer 6

delay non-urgent invasive dental proceudures where possible

Question 7

pt on NOAC/DOAC and low bleeding risk

Answer 7

treat without interupting medication

Question 8

pt on NOAC and higher bleeding risk

Answer 8

• Miss morning dose (apixaban or dabigatran)
• Delay morning dose until 4 hours after haemastasis reached (rivaroxaban or edoxaban)

Question 9

pt on warfarin (or any vit k anatgonist) how do you manage

Answer 9

• Check INR (within 24 hrs before if unstable; within 72 if stable)
• If INR <4 treat without interrupting medicaiton
• strongly consider suturing and packing

Question 10

pt on antiplatelet drug how do you manage

Answer 10

Treat without interrupting medicaiton
- limit initial treatment area
- consider staging excessive or complex procedures
- use local haemostatic measures

Question 11

if unsure about how to manage a patient what would you do

Answer 11

consult with prescribing clinician

Question 12

Dental procedures unlikely to cause bleeding

Answer 12

• LA (infiltration or block)
• BPE
• Supragingival PMPR
• Direct or indirect restorations with supragingival margins
• endodontics
• impressions and other pros
• fitting ortho appliances

Question 13

Dental procedures low risk of bleeding complications

Answer 13

• simple extractions (1-3 teeth, with restricted wound size)
• incision and drainage of IO swellings
• 6PPC
• Sub gingival PMPR
• Direct or indirect restorations with subgingival margins

Question 14

Dental procedures at higher risk of bleeding complications

Answer 14

• complex extractions
• adjacent extractions that will cause a large wound
• extractions of >3 teeth at once
• any flap raising procedures
• gingival recontouring
• biopsies