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2 - Diseases Of The Human System > Coagulation Disorders > Flashcards

Coagulation Disorders Flashcards

1
Q

What are classes of injectable anticoagulatant?

what are the two types

A

herparin

Unfractionated Heparin - rapid acting, inhibits antithrombin 3, used mainly in hospitals
Low Molecular Weight Heparin - longer acting, given subcutaneously daily

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2
Q

What are the two classes of oral anticoagulation?

A

courmarin, non-coumarin based

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3
Q

What are examples of antiplatelet medication?

A

aspirin/clopidogrel, new drugs

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4
Q

Why is aspirin taken in combination with some antiplatelets?

A

to reduce function/adhesion of platelets

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5
Q

What are dental (general) preventaive measures that reduce bleeding procedures?

A

*Regular dental care
*Dietary advice
*Oral Hygiene
*Fluoride supplements
*Fissure sealant

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6
Q

What are safe dental preocedures for all drugs?

A

*Hygiene therapy
*Removable Prosthodontics
*Restorative dentistry, including crowns and bridges.
*Endodontics
*Orthodontic treatment

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7
Q

What are dental procedures that require caution?

A
  • Extractions
  • Minor oral surgery
  • Implants
  • Periodontal surgery
  • Biopsies - sometimes
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8
Q

What are medical indications for anticoagulation drugs for life?

A

Conditions where blood clots will form too readily on or in the circulation

Atrial fibrillation
Deep venous thrombosis
Heart valve disease and Mechanical heart valves
Thrombophilia

ask patient about medications

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9
Q

How does warfarin work?

A

vitamin k antagonist
Slow onset over THREE days
Initial HYPERCOAGULABILITY (therefore use heparin) due to protein C & S inhibition first
Inhibits production of Vitamin K dependent clotting factors 2, 7, 9, 10

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10
Q

What are the vitamin k dependant clotting factors that warfarin inhibits?

what factors cause the hypercoagulation state

A

2, 7, 9 10

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11
Q

What is the warfarin response measured using?

A

INR
prothrombin > thrombin

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12
Q

What is the normal INR for someone on warfarin?

A

2-4

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13
Q

When would the value of INR be raised in a patient on warfarin?

A

3-4 in prosthetic valves and higher risk of DVT

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14
Q

How often should the INR be cheked?

A

every 4-8 weeks

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15
Q

What should be done for a patient on warfarin awaiting dental procedures likely to cause haemorrhage?

A

INR & FBC blood test within 72 hours of treatment

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16
Q

What are examples of local haemastatic measures?

A

cellulose sponge/gauze
sutures
LA

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17
Q

What medications should not be prescribed for dental patients on warfarin?

A

Aspirin (as an analgesic)

NSAIDs including Ibuprofen, Diclofenac

Azole antifungal drugs
Fluconazole
Itraconazole
Miconazole

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18
Q

What are the hazards of taking warfain and how is it treated?

A

haemorrhage
* Usually this is from TRAUMA such as hip/bone fracture
following a fall
* Soft tissue injury leading to bleeding into muscles
* RAPID reversal of anticoagulation with Vitamin K injection possible – only in a hospital setting

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19
Q

Advantages VS Disadvantages of NOACs?

A

Advantages
* No need to monitor action – predictable bioavailability
* Rapid onset of action – within an hour of dose
* Reduced interactions with food/drugs

Disadvantages
* Short duration of action, may only be used for short treatments

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20
Q

How do NOAC work?

A

act by preventing the effect of factor X

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21
Q

How should you treat someone on NOAC?

high/low procedure?

A
  • Treat early in the day. Limit initial treatment
  • LOW risk procedure – no NOAC change
  • HIGHER risk procedure – miss/delay morning dose
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22
Q

What are the NOAC interations?

A

Avoid macrolide antibiotics (Erythromycin and Clarithromycin)

Avoid NSAID

23
Q

What do antiplatelet drugs do?

A

§Inhibit platelet aggregation
§Inhibit thrombus formation in the arterial circulation
§Often used in combination

24
Q

What is very important when patient is on antiplatelet drugs?

A

§VERY important not to stop drug if patient has coronary artery stent in place

25
Q

How should you treat someone on aspirin therapy alone?

A
  • Treat without interrupting medication
  • Local haemostatic measures
  • Consider limiting initial treatment area
26
Q

How should you treat someone on non-aspirin single therapy & dual therapy WITH aspirin?

A
  • Do not interrupt treatment
  • Expect prolonged bleeding – limit initial area
  • Local Haemostasis essential
27
Q

How should you treat someone on two antiplatelet drugs in combination without aspirin?

A
  • Discuss with Doctor stop one of the drugs 7 days prior to surgery
  • If this is not possible refer to a hospital unit
  • Local measures to aid haemostasis
  • Good post operative instructions
  • Must include emergency contact details
28
Q

What are the interations antiplatelets may have?

A

Avoid additional NSAIDs where possible

Carbamazepine and Omeprazole may reduce the efficacy of the Antiplatelet drugs.

29
Q

What might inherited bleeding disorders affect?

A

COAGULATION CASCADE
* A reduction or in one, or more, of the coagulation factors or control proteins
* Too LITTLE clot formed – Haemophilia
* Too MUCH clot formed - Thrombophilia

PLATELETS
* Number
* Function

A COMBINED DEFICIENCY

30
Q

What are disorders reducing coagulation factors and what factor do they affect?

A

Factor VIII deficiency - Haemophilia / Haemophilia A

Factor IX deficiency - Christmas disease / Haemophilia B

Vonwillebrand Disease -Reduced factor VIII level and platelet aggregation

Factor XI (Haemophilia C) deficiency - Common in the Ashkenazy Jew population

31
Q

How is haemophilia a and b inherited?

A

Inheritance - Sex-linked recessive
* defective gene on the X chromosome
* Males are affected and females are carriers

32
Q

How is the severity of haemophilia A managed?

severe/moderate VS mild

A

Severity of disease depends upon the amount of factor produced

Severe and moderate: factor 8 replacement therapy

Mild: DDAVP (desmopressin) or antifibrinolytic agents like tranexamic acid.

33
Q

DDAVP VS Transexamic acid

A

desmopressin – releases factor VIII that has been bound to endothelial cells giving a temporary boost to Factor VII levels and clotting ability

tranexamic acid - inhibitor of fibrinolysis (keeps any clot that is formed)

34
Q

How is severe and moderate haemophilia B managed VS how is mild haemophilia B managed?

A

both require the use of (replacement therapy) recombinant factor IX

35
Q

What are coagulation factor inhibtors?

A

development of coagulation factor inhibitors (antibodies against factors VIII and IX) as a complication of treatment (reduce treatment episodes)

36
Q

What type of disease is vone willebrand’s disease?

A

Autosomal dominant – NOT transmitted by the X chromosome
* Both sexes equally affected
* Deficiency of von Willebrand factor
* reduction in factor VIII levels
* Most prevalant in UK

37
Q

How is severe and moderate von willebrand’s disease managed VS mild/carrier ?

A

severe/moderate: DDAVP enough for most

mild: oral tranexamic acid

38
Q

Why is management of rarer bleeding disorders complex?

A

bleeding does not always relate to the factor levels

39
Q

Where is severe and moderate VS mild haemophilia treated in dental care?

A

Severe/Moderate: dental treatment unit attached to the Haemophilia centre. prosthodontics and other no-risk treatments can be in primary care.

Mild: GDP. patient reviewed at haemophilia centre every 2 years

40
Q

What are the 5 dental procedures that require care in hameophilic patients?

A
  • Administration of local anaesthesia
  • Extractions
  • Minor oral surgery
  • Periodontal surgery
  • Biopsies
41
Q

What types of LA are safe in haemophilia?

A
  • Buccal infiltration
  • Intraligamentary injections
  • Intra-papillary injections
42
Q

What types of LA are dangerous in haemophilic patients?

A
  • Inferior alveolar nerve block
  • Lingual infiltration
  • Posterior Superior nerve block
43
Q

How should extractions/ surgeries be taken for severe VS mild haemophilic patients

A

severe: patients should be observed overnight following surgery.

mild: patients observed 2-3 hours after surgery

44
Q

What is thrombophilia and how does it happen?

A

Increased risk of clots developing
Often an acquired condition superimposed on a genetic tendency
* Can present any point in life

45
Q

What happens if the clot embolises in throbophilia?

A

can lead to blockage of major blood vessels in the heart and/or lungs
* pulmonary thromboembolism
* Life threatening in many cases

46
Q

What are the inherited hypercoagulation syndromes?

A
  • Protein C deficiency
  • Protein S deficiency
  • Factor V Leiden
  • Antithrombin III deficiency
47
Q

What are the aquired hypecoagulation syndromes?

A
  • Antiphospholipid syndrome (Lupus anticoagulants)
  • Oral contraceptives
  • Surgery
  • Trauma
  • Cancer
  • Pregnancy
  • Immobilisation
48
Q

What is reduced platelet numbers called?

A

thrombocytopenia

49
Q

What is increased platelet numbers called?

A

thrombocythemia

platelets do not work despite increase

50
Q

What are the causes of thrombocytopenia?

A

Idiopathic (unknown cause)

Drug related Alcohol
Penicillin based drugs Heparin

Secondary to lymphoproliferative disorder - leukaemia or myelodysplasia

51
Q

What are patients with throbocythemia usually on?

A

aspirin to prevent clot formation

52
Q

What are examples of inherited qualitative diseases?

platelets are normal in number, but abnormal in function

A

Bernard Soulier Syndrome
Hermansky Pudlak
Glanzmann’s thrombasthenia

53
Q

What are examples of acquired qualitative diseases?

platelets are normal in number, but abnormal in function

A

Associated with liver cirrhosis
Caused by certain drugs
Caused by alcohol use
Occurring after cardiopulmonary bypass procedures

54
Q

When is special care taken for patients with platelet disorders?

platelet count and dental procedures

A

If the Platelet count is:
* BELOW 100x109/L - primary care treatment
* BELOW 50x109/L – hospital treatment
* above 500 x 109/L – either hospital or primary care setting

above 100x109 is normal - precaution

SPECIAL CARE is REQUIRED for:
* Extractions
* Minor oral surgery
* Periodontal surgery
* Biopsies

2 - Diseases Of The Human System (19 decks)

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