Anticoagulation and anti-platelet drugs Flashcards
Diseases of the blood
What is injectable anticoagulation?
Heparins- unfractionated and low molecular weight heparin
How is unfractionated heparin administered and how is low mw heparin administered?
Unfractionated heparin-Via infusion only active for a few minutes
Low mw heparin- subcutaneous injection 1x a day
How does unfractionated heparin work and how does low mw heparin work?
Unfractionated- allows rapid control, rapid onset and quick end to effect, inhibits antithrombin 3 preventing its action RARELY DENTAL ISSUE
Low mw heparin- stops low level excess clotting without increasing bleeding risk
NO PRACTICAL DENTAL ISSUES
What are the types of oral anticoagulation?
Coumarins and non-coumarins
What are dental care procedures you should be cautious with for people taking these drugs?
Extractions, minor oral surgery, implants, periodontal surgery and biopsies sometimes
What are some indications for anti coagulation?
Conditions where blood clots will form too readily on or in the circulation e.g. atrial fibrillation, DVT, heart valve disease, mechanical heart valves and thrombophilia
Give an example of a factor xa inhibitor and a coumarin.
FXA- apixaban
coumarins- warfarin
How is warfarin response measured?
International normalised ratio- normal is 2-3 and 3-4 in prosthetic valves and higher risk of DVT
How often should warfarin be checked?
Every 4-8 weeks, more often if value is unstable and all patients should carry a recording anti-coag booklet
What can upset the INR?
Foods and medicines interacting with warfarin
How do we proceed with dental procedures likely to cause haemorrhage for patients taking warfarin?
INR and FBC blood test within 72 hours of treatment, 24 is preferred, early in the day + week, if INR <4 proceed with caution, apply local haemastatic measures and post-op instructions with contact number
Which drugs increase INR when taking warfarin? 4
Amiodarone, antibiotics, alcohol w. liver disease and NSAIDs
Which drugs reduce INR when taking warfarin? 5
Carbamazepine, barbiturates, cholestyramine, griseofulvin and alcohol w.out liver disease
What medications to avoid giving to those dental patients on warfarin
Aspirin for analgesia, NSAIDs, azole antifungal drugs
What are the hazards of taking warfarin?
Haemorrhage needing hospitalisation can be fatal, can be from trauma such as hip/bone fracture after a fall, soft tissue injury leading to bleeding in muscles
How do you reverse anticoagulation rapidly in a hospital setting?
Vitamin K injections
What are NOAC’s?
New oral anti-coagulants
How do NOACs work?
Prevent the effect of Factor X- no need to monitor action, rapid onset within an hour, short duration of action (lost within a day)
Give an example of a NOAC
Apixaban 2x daily
How do we proceed with dental treatment for those with NOAC? Extraction aswell
Assess bleeding risk of procedure- treat earlier day, if its a higher risk procedure, miss/delay morning dose and restart dose immediately after treatment for once daily and omit 1st and take 2nd daily dose for twice daily, IDB if needed and local haemostatic measures
Extraction- do at beginning of the day at beginning of the week and keep for atleast 20 min post op to assess bleeding
What are dental drug interactions with NOAC?
Safe with antifungals, antivirals, and local anaesthetic **
