Anticoagulation and Antiplatelet Drugs

Question 1

what are the injectable anticoagulants?

Answer 1

heparins

Question 2

what are the oral anticoagulants?

Answer 2

coumarin/non-coumarin

Question 3

what are the antiplatelet medications?

Answer 3

aspirin/clopidogrel/new drugs

Question 4

what are he two types of heparins?

Answer 4

unfractionated and low molecular weight

Question 5

how is unfractionated heparin given?

Answer 5

by infusion and only active for a few minutes

Question 6

what does unfractionated heparin allow?

Answer 6

rapid control - rapid onset and quick to end

Question 7

what does unfractionated heparin do?

Answer 7

inhibits antithrombin 3 preventing its action

Question 8

where is unfractionated heparin given?

Answer 8

hospitals for operations

Question 9

how is low molecular weight heparin given?

Answer 9

subcutaneously daily

Question 10

what does low molecular heparin do?

Answer 10

stops low level excess clotting without increasing bleeding risk

Question 11

list some oral anticoagulants

Answer 11

warfarin, apixaban, edoxaban, rivaroxaban, dabigatran

Question 12

list some oral antiplatelets

Answer 12

low dose aspirin, clopidogrel, dipyridamole

Question 13

what are the safe dental procedures for all drugs?

Answer 13

hygiene therapy, removable pros, restorative dentistry, endodontics, orthodontic treatment

Question 14

what dental procedures should you treat with caution?

Answer 14

extractions, minor oral surgery, implants, periodontal surgery, biopsies

Question 15

what are the indications for anticoagulation?

Answer 15

conditions where blood clots will form too readily on or in the circulation - atrial fibrillation, deep venous thrombosis, heart valve disease, mechanical heart valves, thrombophilia

Question 16

what is the common type of coumarin?

Answer 16

warfarin

Question 17

name an indanediones

Answer 17

phenindione

Question 18

name a direct thrombin inhibitor

Answer 18

dabigatran

Question 19

name factor Xa inhibitors

Answer 19

apixaban, ravaroxaban, edoxaban

Question 20

what does warfarin do?

Answer 20

inhibit production of vitamin K dependent clotting factors - 2,7,9,10

Question 21

describe the onset of warfarin?

Answer 21

slow onset over 3 days as existing factor have to be consumed

Question 22

why do warfarin takers have to take heparin?

Answer 22

due to the initial hypercoagulability

Question 23

how is warfarin response measured?

Answer 23

INR

Question 24

what is the normal INR value for warfarin patients?

Answer 24

2-3 or 3-4 with prosthetic valves

Question 25

how often should INR be checked for warfarin patients?

Answer 25

every 4-8 weeks

Question 26

what must warfarin patients have done within 72 hours of dental procedures with risk of haemorrhage?

Answer 26

INR and FBC blood tests

Question 27

when should you treat patients on warfarin?

Answer 27

early in the day and early in the week

Question 28

which drugs increase INR?

Answer 28

amiodarone, antibiotics, alcohol, NSAIDs

Question 29

what drugs reduce INR?

Answer 29

carbamazepine, barbiturates, cholestyramine, griseofulvin, alcohol

Question 30

what medications should you avoid prescribing for dental patients on warfarin?

Answer 30

aspirin as analgesic, NSAIDs including ibuprofen, azole antifungal drugs (fluconazole)

Question 31

what are the hazards from taking warfarin?

Answer 31

haemorrhage

Question 32

what can you take if a person of warfarin has a haemorrhage?

Answer 32

vitamin K injection for reversal of anticoagulation

Question 33

how can haemorrhage occur?

Answer 33

trauma such as hip/bone fracture following a fall or soft tissue injury leading to bleeding muscles

Question 34

what is the advantages of NOACs

Answer 34

predictable bioavailability, rapid onset of action within an hour of dose, short duration of action so the effect is lost within a day

Question 35

how do NOACs work?

Answer 35

by preventing the effect of factor X

Question 36

give examples of NOACs

Answer 36

rivaroxiban, apixaban given twice daily

Question 37

when should you treat patients on NOACs

Answer 37

early in day early in week

Question 38

what must happen if you are performing a high risk procedure on a NOAC patient?

Answer 38

miss/delay morning dose of NOACs then restart immediately after treatment

Question 39

what planning procedures for NOAC patients are important with regards to dental treatment?

Answer 39

IDB needed? local haemostatic measures in place, extraction at beginning of day at beginning of week, keep 20mins post extraction to assess bleeding

Question 40

what dental drugs are safe for use with NOACs?

Answer 40

dental antibiotics (except fluconazole), antifungals, LA, antivirals

Question 41

what dental drugs should be avoided with NOAC patients?

Answer 41

NSAIDs and carbamazepine

Question 42

what is the standard therapy of antiplatelet medicines given?

Answer 42

low dose aspirin, clopidogrel, dipyridamole

Question 43

what is the advanced cardiac therapy antiplatelet medicines given?

Answer 43

prasugrel + aspirin, abciximab, eptifibate + aspirin, ticagrelor, tirofaban

Question 44

what do antiplatelet drugs do?

Answer 44

inhibit platelet aggregation, inhibit thrombus formation in the arterial circulation

Question 45

what are the dental considerations with a patient on aspirin alone?

Answer 45

treat without interrupting medication, local haemostatic measures, consider limiting initial treatment area

Question 46

what should the dental considerations be for patients on non-aspirin therapy or dual therapy with aspirin?

Answer 46

do not interrupt treatment, expect prolonged bleeding, local haemostasis essential

Question 47

what should the dental considerations be if two antiplatelet drugs are taken but without aspirin?

Answer 47

discuss with doctor to stop one of the drugs 7 days before surgery, if not possible then refer to hospital unit

Question 48

what must post-operative instructions contain?

Answer 48

include emergency contact details

Question 49

what drugs should you be careful with for patients on antiplatelets?

Answer 49

NSAIDs, erythromycin, fluconazole, clarithromycin, carbamazepine/omeprazole