Anticoagulation and Dentistry Flashcards
anticoagulants/ antiplatelets given for?
vascular/thromboembolic
cardiac conditions
history of stroke
heart valve
anticoagulants and antiplatelets decrease what and increase what?
decrease risk of thrombeoembolic events and increase risk of bleeding - spont./tx
common types of anticoagulants/platelets?
vit K antagonists
antiplatelets
novel oral anticoagulants
what does warfarin antagonise?
how long for drug to develop fully?
limitations?
antagonises vit K
48-72 hours
action reversible with vit K
narrow therapeutic range, sensitive to diet, drug interactions
what is the INR?
what value of INR will clott start to take longer?
prothrombin time
INR >1
what to check with pt about INR before starting exam?
checked in last 72 hours
INR stable
INR
what is the BNF’s definition of a stable INR?
not been over four in last two months
does not require weekly monitoring
what to do if INR > 4?
contact gmp, delay tx, ref to 2ndry dental care
how to limit initial tx area?
single extraction if poss
scaling, rsd restricted to limited area
asses potential for bleeding
after extraction do what to help stop bleeding?
suture over socket with an absorbable haemostatic dressing
warfarin pt’s when to give app’s
start of day, start of week
LA and warfarin pt’s?
unlikely to cause bleeding
post op instructions?
NHS 111, local A/E, painkillers, pain relied, no aspirin or any other NSAIDS
contact gmp if?
unstable INR, INR >4 in last 2 months, other disorders of haemostasis, renal failure, liver disease, alcoholism, cytotoxic drugs and radiotherapy
what increases warfarin activity?
antibacs - e.g amoxicillin
antiepileptics - phenytoin
antifungals, hormones, cardiac drugs, analgesics
