Anticogulants Revision Questions

Question 1

Warfarin

Answer 1

Vitamin k anticogulant that inhibits Vit K function and decreases clotting factors
inhibits Vit K, protein C&S, factor VII, X, IX, II

Question 2

Blood test for warfarin

Answer 2

INR - if stable inr does not require weekly montiring and level not above 4 in last 2 months
can be checked 24 hours before dental work
72 hours if stable

Question 3

What to do if someone is on warfarin and requires XLA

Answer 3

plan treatment for early in day and week
approproaite measures for heamostasis
consider staging treatment
advice on use of paracetamol instead of NSIADS
provide written instructions and emergency detials

Question 4

If treatment is likely cause bleeding

Answer 4

ensure patients INR has been checked, ideally no more tham 24hours before treatment
if INR > 4 delay treatment until reduced
if INR < 3 treat without interupting their anticogulant
carry out no more than 3XLAs at a time - higher risk of bleeding

Question 5

What is INR

Answer 5

prothrombin time/reference PT plasma

Question 6

Cogesitve heart failure symptoms

Answer 6

chest pain when breathing
short of breath
swelling of legs and ankles
fast irrgular pulse
fatigue
wheezing
coughing

Question 7

Apixban

Answer 7

Factor Xa inhibtors which work by blocking action of activated factor X which is needed for forming clot - taken x2 daily

Question 8

Dabigatra

Answer 8

Direct inhibitor of cogulation factor trhombin - take x2 day

Question 9

Rivaroxaban

Answer 9

usually taken once daily

Question 10

Patient on apixiban/dabigatra

Answer 10

activated partial thromboplastin

Question 11

Patient on rivaroxaban

Answer 11

Prothrombin time

Question 12

Mangement of patients with low risk of bleeding on NOACs

Answer 12

plan treatment for early in day to allow montoring
limit the intial treatment area
use local haemostatic measures

Question 13

Management of patients with high bleeding risk on NOACs

Answer 13

advise patient to miss their morning dose on day of treatment
plan treatment for early in day to allow monitoring
consider carrying treatments in a stage order
for rovaroxaban - the delayed morning dose can be taken 4hrs after haemostasis has been achieved
apixiban/dabigatra - patient should take their evening dose at usual time as long as it is more than 4hours since haemostasis has been achieved