anticoagulation & antiplatelet drugs

Question 1

what are the types of antithrombotic medication?

Answer 1

injectable anticoagulation
-heparins
oral anticoagulation
-coumarin, non-coumarin
antiplatelet medication
-aspirin/clopidogrel, new drugs

Question 2

describe unfractionated heparin

Answer 2

given by infusion
only active for a few mins
rapid control eg surgery
rapid onset & removal
inhibits antithrombin 3 preventing action
hospital based tx

Question 3

describe low molecular weight heparin

Answer 3

subcutaneous injection once daily
stops low level excess clotting w/o increasing bleeding risk
unpleasant
no dental issues

Question 4

what are the anticoagulants?

Answer 4

warfarin
apixaban
edoxaban
rivaroxaban
dabigatran

Question 5

what are the antiplatelets?

Answer 5

low dose aspirin
clopidogrel
dipyridamole
prasugrel + aspirin
abciximab
eptifibate + aspirin
ticagrelor
tirofaban

Question 6

what are safe dental procedures for all drugs?

Answer 6

hygiene therapy
removable pros
rest. dentistry
endoontics
ortho

Question 7

which dental procedures can be done with caution?

Answer 7

extractions
minor oral surgery
implants
periodontal surgery
biopsies

Question 8

which conditions do clots form too readily on/in circulation?

Answer 8

atrial fibrillation
deep venous thrombosis
heart valve disease
mechanical heart valves
thrombophilia

Question 9

describe the action of warfarin

Answer 9

onset over 3 days
initial hypercoagulability due to protein c and s inhibition
inhibits production of vit K dependent clotting factors
delay in onset as existing factor have to be consumed

Question 10

how is INR used with warfarin?

Answer 10

measures response
normal 2-3
3-4 when prosthetic valves
checked every 4-8 weeks
-more often if unstable
drug interactions, food
anticoag booklet

Question 11

how should dental px on warfarin be treated?

Answer 11

procedures can cause haemorrhage
INR & FBC w/i 72 hours tx
early in day and week
INR <4 caution
local haemostatic measures applied- cellulose sponge, sutures, LA around socket
post op important

Question 12

what drugs interact with warfarin to increase INR?

Answer 12

amiodarone
antibiotics
alcohol (liver disease)
NSAIDS

Question 13

what drugs interact w/ warfarin to reduce INR?

Answer 13

carbamazepine, barbiturates
cholestyramine
griseofulvin
alcohol

Question 14

what medications should you not prescribe to warfarin px?

Answer 14

aspirin
NSIADS
azole antifungals
-fluconazole
-itraconazole
-miconazole

Question 15

what are the hazards of taking warfarin?

Answer 15

haemorrhage
-1% yearly risk
eg trauma
rapid reversal w/ vit K possible

Question 16

describe new oral anticoagulants

Answer 16

predictable bioavailability
- no need to monitor
short duration of action 1 day
may only be short tx
reversal available

Question 17

what are the new oral anticoagulants?

Answer 17

rivaroxaban qd
apixaban bds
edoxaban qd
dabigatran qd

Question 18

how do you treat a dental px with NOAC?

Answer 18

assess bleeding risk of procedure
early in day
low risk no change
high risk miss dose
local haemostatic measures
keep 20 mins post extraction
IBD if needed

Question 19

NOAC interactions

Answer 19

NSAID
carbamazepine
macrolides
-erythromycin, clarithromycin

Question 20

what are the standard antiplatelet medicines?

Answer 20

aspirin 75mg
clopidogrel
dipyridamole

Question 21

what are the advanced cardiac therapy antiplatelets?

Answer 21

prasugrel + aspirin
abciximab
eptifibate + aspirin
ticagrelor
tirofaban