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clotting Flashcards

1
Q

what are the components of blood involved in clotting

A

coagulation factors and platelets

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2
Q

describe the coagulation process

A
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3
Q

which medications can affect clotting

A
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4
Q

what are the most common inherited blood disorders

A
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5
Q

describe the importance of clotting in dentistry

A
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6
Q

what are the stages to clotting

A

injury to a vessel
vascular phase, whereby the vessel attempts to stop the bleeding
platelet phase aka primary haemostats
coagulation phase aka secondary haemostats
clot formation and stabilisation
clot dissolution

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7
Q

describe the vascular phase of clotting

A

this is when the vessel attempts to stop the bleeding
the vessel will vasoconstriction, via smooth muscle action.
injury exposes the collagen in the blood vessel wall, and the fibres will kickstart the healing process.

there is release of factors from the endothelial cells lining the vessel, which includes
- adp platelets
- tissue factor
- endothelins

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8
Q

describe the platelet phase of clotting

A

this is when the exposed collagen, apd and endothelins attract platelets.
the platelets become sticky and adhere to each other, causing a platelet plug via aggregation.

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9
Q

how does the platelet plug form

A

the exposed collagen released ADP and endothelia’s which attracts the platelets.
there is platelet adhesion and aggregation, which leads to more adp and thromboxane a2 being released which attracts more platelets. this is positive feedback.
this plugs the vessel injury but is a temporary solution, as the weaker repair compared to the finished product

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10
Q

what is the aim of the coagulation phase

A

to create a more permanent, robust clot

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11
Q

what is the clot made from

A

fibrin

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12
Q

what is the coagulation cascade

A

a series of proteins ultimately leads to clot formation through two separate pathways; intrinsic and extrinsic
parallel to this is fibrinolysis which is clot breakdown to prevent spontaneous clotting in health

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13
Q

where does the intrinsic coagulation cascade occur

A

in the bloodstream

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14
Q

where does the extrinsic coagulation cascade occur

A

in the vessel wall

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15
Q

what are some medications that affect platelets

A

aspirin
clopidogrel
dipyridamole
ticagrelor

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16
Q

what are some medications that act as anti coagulants

A

warfarin
edoxaban
rivaroxaban
apixaban
dabigatran

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17
Q

why would someone be prescribed a blood thinner

A

coronary disease to prevent myocardial infarction or stroke
peripheral artery disease to reduce symptoms
prosthetic heart valves to prevent a clot
atrial fibrillation to prevent a stroke
pulmonary embolisms and deep vein thrombosis to treat or prevent the conditions
following surgery or pregnancy

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18
Q

what is coronary artery disease

A

narrowing of the vessels supplying blood to the heart

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19
Q

what is peripheral artery disease

A

narrowing of the vessels supplying the legs or the arms

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20
Q

what is atrial fibrillation

A

heart arrhythmia

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21
Q

how many mg aspirin a day

A

75mmg

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22
Q

how many mmg aspirin is given in acute myocardial infarction or in a stroke

A

300mmg

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23
Q

what is the mechanism of action of aspirin

A

inhibits the COX enzyme, reducing production of thromboxane A2, thereby reducing the platelet aggregation

interfering with the canalisation of the formation of thromboxane a2 prevents platelet aggregation, which is irreversible, and the platelets live for 7-10 days. should be familiar with this mechanism of action. the membrane f the platelet will begin to break down

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24
Q

do people need to stop taking aspirin for dental treatment

A

no

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25
what is the lifespan of platelets
7-10 days
26
what is the common dose of aspirin
75 mmg
27
what is aspirin used for
preventing blood clots in vessels when they are narrowed due to atherosclerotic disease
28
what are some conditions requiring 75mmg aspirin a day
coronary artery disease, secondary prevention transient ischaemic attack, secondary prevention
29
describe warfarin
this drug is used less nowadays but it inhibits the production of vitamin k which is essential in formation of coagulation factors 2, 7, 9 and 10. used for prosthetic heart valve patients as they have a risk of clotting due to blood stagnation
30
what is the INR
international normalised ratio used to monitor warfarin
31
what are the indications with medications and food stuffs observed in warfarin
metronidazole fluconazole NSAIDs alcohol grapefruit
32
describe DOACs
these are direct oral anticoagulants including ecoxaban, rivaroxaban, apixaban, dabigatran these are taken over from warfarin for conditions such as atrial fibrillation, PE and DVT
33
what is the mechanism of action of DOACs
inhibits factor Xa and inhibits free thrombin
34
does DOAC require monitoring
no
35
compare warfarin vs DOACs for onset
slow vs rapid
36
compare warfarin vs DOACs for dosing
variable vs fixed
37
compare warfarin vs DOACs for food effect
yes vs no
38
compare warfarin vs DOACs for drug interactions
many vs a few
39
compare warfarin vs DOACs for monitoring
yes vs no
40
compare warfarin vs DOACs for offset
long vs shorter
41
describe injectable anticoagulants
used after giving birth or during long hospital stays or where patients are unable to take DOACs
42
what is the mechanism of action of injectable anticoagulants
inhibits the formation of factor Xa and thrombin
43
what are some injectable anticoagulants
dalteparin enokaparin
44
what are the general principles for dentistry and anti coagulant medications
delay dental treatment until the anticoagulant plan finishes plan treatment for early in the week and in the day atraumatic surgery consider packing and suturing ensure bleeding has stopped advise paracetamol for pain relief
45
what are bleeding disorders
these are disorders where there is impairment of the different elements of clotting, like the platelets, clotting factors or in liver disease
46
what are some acquired bleeding disorders
liver disease thrombocytopenia
47
what are some inherited bleeding disorders
von willebrand disease haemophilia A haemophilia B
48
describe liver disease in relation to bleeding disorders
can result in a bleeding tendency due to reduced platelet numbers and function the thrombopoeitin hormone stimulates platelet production and is produced in the liver there is also impaired production of coagulation factors
49
describe thrombocytopenia
this is when there are low platelet numbers due to reduced production or increased destruction
50
how does reduced platelet production occur
b12 deficiency folic acid deficiency liver disease leukemia chemotherapy
51
how does increased destruction of platelets occur
immune drive, top or heparin induced thrombocytopenia
52
describe von willebrand disease
this is the most common inherited cause of abnormal and prolonged bleeding an autosomal dominant inheritance, causing an absent or defective von willebrand factor this leads to impaired platelet aggregation and impaired transport of factor 8 to the wound
53
what is type 1 von willebrand
this involves partial deficiency of von willebrand factor, the most common and mildest type
54
what is type 2 von willebrand
this involves reduced function of von willebrand disease
55
what is type 3 von willebrand disease
this involves a complete deficiency of von willebrand factor and is the most rare and severe type
56
what is the inheritance type of each von willebrand disorder
type 1 is autosomal dominant type 2 is autosomal dominant type 3 is autosomal recessive
57
describe von willebeand disease in dentistry
does not require daily treatment, but for dental treatment likely to cause bleeding, should cover with: - tranexamic acid mouthwash if disease is mild and the procedure is low risk - DDAVP/desmopressin if more likely to cause bleeding - von willebrand factor concentrate if severe disease and high risk procedure
58
how does DDAVP and desmopressin work
increases von willebrand factor production and factor 8 production
59
describe the inheritance pattern of haemophilia
x linked recessive, primarily affecting males
60
describe haemophilia A
this affects deficiency factor 8
61
describe haemophilia B
this affects deficiency of factor 9
62
what does haemophilia present as
spontaneous bleeding into joints and significant bleeding following minor trauma
63
how is haemophilia A treated
DDAVP/desmopressin or factor 8 concentrate if more severe
64
how is haemophilia B treated
factor 9 concentrate, as DDAVP is not effective
65
how long before dental treatment should blood products be given to haemophiliac patients
30 minutes
66
factor percentage of severe haemophilia
less than 1%
67
factor percentage of moderate haaemophilia
2-5%
68
factor percentage of mild haemophilia
6-40%
69
describe dental treatment for severe haemophilia
enhanced preventative advice and treatment all treatment except for prosthetics carried out in hospital setting
70
describe dental treatment for moderate haemophilia
enhanced preventative advice and treatment manage as for severe haemophilia
71
describe dental treatment for mild haemophilia
enhanced preventative advice and treatment not all treatments in hospital , seen every two years in specialist dental team at haemophilia centre
72
what to note when administering local anaesthetic to bleeding disordered patients
avoid the inferior alveolar nerve block as there is risk of bleeding from the. muscle. can lead to haematoma or airway compromising
73
what administration for local anaesthetic is preferred for patients with bleeding disorders
buccal infiltration intra papillary injections intra ligamentary injections
74
what are the four blood tests related to clotting
full blood count liver function est inr coagulation screen
75
what is the full blood count
counting red cell, white cell and platelet
76
what is the liver function test
this shows the acute liver damage most coagulation factors are made in the liver less helpful about specific synthetic function
77
what is the INR
the international normalised ratio used to compare how long it takes patients blood clotc compared to laboratory standard the higher the number, the longer it takes to clot usual range for patients on warfarin is 2-4 healthy person on no medication is 1 normally should be less than 4 for medical treatment
78
what is coagulation on screen
this looks at intrinsic and extrinsic pathways and gives good insight into livers synthetic function
79
what is thrombophilia
too much clotting there are elements of the clotting cascade that prevent over clotting, protein c, protein s and antithrombin. antiphospholipid syndrome or deficiency of protein c or s can lead to over clotting
80
what are some conditions featuring over clotting
pulmonary embolism (blood clot in the lung) deep vein thrombosis (blood clots in the limbs, often in the leg)
81
what are the risk factors for thrombophilia
previous DVT/PE prolonged immobility plaster cast combined oral contraceptive pill surgical operation acutely unwell eg sepsis cancer dehydration pregnancy
82
how is thrombophilia managed
anticoagulant medications - making them a bleeding risk in dental practice

Human Systems and Anatomy (57 decks)

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