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BDS2 BAMS > coagulation disorders > Flashcards

coagulation disorders Flashcards

1
Q

why do you need to know about the anticoagulants or platelets disorders that someone has as a dentist?

A

if they have a clotting disorder and are not on medications, they might bleed to death

those on anticoagulants require tx planning to prevent bleeding risks

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2
Q

what are safe dental procedures that do not require patients to alter their anticoagulant schedule?

A

o hygiene therapy
o pros
o restorative
o crowns
o bridges
o endodontics
o orthodontics

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3
Q

what are risky procedures that dentists need to consider for patients on anticoagulants?

A

minor oral surgery
extractions
perio surgery
implants
biopsies

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4
Q

3 types of antithrombocytic medication

A

1injectable anticoagulants
2 oral anticoagulants
3 antiplatelets

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5
Q

what is unfractionated heparin and when is it used

A

it is an injectable anticoagulant

  • rapid control
  • temporary, only active for a few minutes
  • used for operations, not practical in dental setting
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6
Q

what is low moledular weight heparin and when is it used?

A

it is a type of injectable anticoagulant

injected once daily

does not interfere with dental tx

stops low level excess clotting without increasing bleeding risk

used for short term hypercoagulability, eg when first starting on warfarin

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7
Q

who needs to take anticoagulants

A

form blood clots too easily

pros valves

thrombophillia

atrial fib

DVT

heart valve disease

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8
Q

most common anticoagulants

A
  • warfarin
  • apixaban
  • dabigatran (direct thrombin inhibitor)
  • rivaroxaban
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9
Q

eg of a coumarin and a non coumarin

A

coumarin = warfarin
non coumarin = apixaban

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10
Q

what factor does apixaban inhibit

A

factor x (10)

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11
Q

what factor does warfarin inhibit

A

it is a vitamin k antagonist

inhibits protein c and s

inhibits production of vitamin k dependent clotting factors 2 7 9 10

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12
Q

why do you need to take heparin when you first start taking warfarin?

A
  • initial hypercoagulability due to protein c and s inhibition
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13
Q

what is the acceptable range of INR for warfarin patietns

A

INR 2- 4

checked every 4-8 weeks for stability

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14
Q

what can INR be upset by

A

drug interactions and food

  • warfarin is heavily bound to plasma proteins, other drugs can displace warfarin from the protein
  • anyone taking warfarin has to take caution with other drugs
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15
Q

as a dentist what precautions do you need to take for warfarin patients

A

drug interactions

local haemostatic measures

check INR within 72 hours of a RISKY procedure

emergency out of hours contact

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16
Q

what drugs interact with warfarin

A

assume all drugs interact with warfarin but mainly

nsaids
aspirin
azole antifungals

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17
Q

what are the hazards of taking warfarin?

A
  • haemorrhage during treatment
  • trauma causing serious bleed
  • soft tissue injury leading to bleeding into muscles
  • rapid reversal of anticoagulation with vitamin k injection in hospital
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18
Q

what is the benefits of DOAC over warfarin

A

DOAC has predictable bioavailability so it doesnt require INR testing

it has rapid onset and short duration of action, effects lost within a day

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19
Q

what do you as a dental professional need to know when treating patients on doac

A
  • low risk procedures do not require changing dose of NOAC
  • high risk procedures can delay the morning dose of NOAC, then restart dose after treatment
  • IDB if needed
  • local haemostatic measures
  • keep for 20min post extraction to assess bleeding
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20
Q

what drugs interact with doac?

A

nsaids
carbamazepine
macrolides
erythromycin
clarithromycin

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21
Q

most common antiplatelet drugs

A
  • aspirin 75mg
  • clopidogrel
  • dipyridamole
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22
Q

when must you NOT stop antiplatelet drugs?

A
  • CANNOT STOP in patients with coronary artery stent
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23
Q

antiplatelets vs anticoagulants

A

antiplatelets - inhibits platelet aggregation

anticoagulants - inhibits factors in the coagulation cascade

24
Q

which drugs interact with antiplatelets?

A
  • NSAIDs
  • Carbamazepine
  • Omeprazole

additionally, clopidogrel interacts with erythromycin and fluconazole

25
Q

as a dentist, do you need to stop patients who are taking aspirin before their procedure?

A

if aspirin alone , no need to stop

if taking aspirin with another antiplatelet, need to expect prolonged bleeding and local haemostatic measures essential + Good post operative instructions with emergency contact details

26
Q

what is an inherited bleeding disorder?

A

acquired defect that affects the coagulation of the blood

27
Q

haemophillia vs thrombophillia

A

Haemophilia = too little clot formed

Thrombophilia = too much clot formed

28
Q

haemophilia A and B affect which chromosome

A

X chromosome

therfore it is sex linked recessive

29
Q

is haemophillia recessive or dominant

A

haemophillia a and b = sex linked recessive

von Willebrand = autosomal dominant

30
Q

which chromosome does von willebrand affect

A

NOT x chromsome, just autosomal

31
Q

haemophillia A is a deficiency of which factor?

A

factor 8

32
Q

haemophillia B is a deficiency of which factor?

A

factor 9

33
Q

von WIllebrand is a deficiency of which factor?

A

factor 8 deficiency +

reduced platelet +

Deficiency of von Willebrand factor

34
Q

what are coagulation factor inhibitors

A
  • Are antibodies
  • That develop after you give treatment ie give factor 8 and 9
  • More treatment, more frequent => higher levels of antibodies=> next dose has to be higher than the previous to overcome the inhibitors
35
Q

DDAVP drug function

A
  • aka desmopressin
  • releases factor 8 that is bound to endothelial cells into the circulation
36
Q

when is DDAVP used?

A
  • used in mild haem a and severe von Willebrand to increase factor 8 in circulation
  • cannot be used in haemophilia b because there is no factor 9 bound to the endothelial cells
37
Q

Tranexamic acid function and when is it used

A

function = inhibitor of fibrinolysis, keeps any clots that are formed

used when = mild von willebrand and mild haem a

38
Q

treatment for haem a

A

Severe and moderate – recombinant factor 8

Mild and carriers –
DDAVP and oral tranexamic acid

39
Q

treatment for haem b

A

Severe and moderate – recombinant factor 9

Mild and carriers – recombinant factor 9

40
Q

treatment for von willebrand

A

Severe and moderate – DDAVP

Mild and carriers –
oral tranexamic acid

41
Q

which bleeding disorder is quite common but most people do not know

A

von Willbrand

42
Q

How is haemophillia related to the dental profession?

A
  • Non bleeding procedures done in primary care
  • Risky procedure done in haemophilia centres/hospital
43
Q

what is considered dangerous local anesthetic for hemophilia patients

A

1 IDB
2 lingual infiltration
3 posterior superior nerve block

44
Q

for extractions done on haemophillia patients, what is the post operative instructions

A

severe - observed overnight in haemophillia unit

mild - observed for 2-3h after surgery + comprehensive post operative instructions + emergency contact

45
Q

how does thrombophilia occur

A
  • Clot formation > clot breakdown
  • Excessive stable clot in circulation
46
Q

causes of thrombophillia

A
  • Can be acquired condition superimposed on a genetic tendency
    o Acquired hypercoagulation
    o Oral contraceptives
    o Surgery
    o Trauma
    o Cancer
    o Pregnancy
  • Could be a problem with fibrinolysis
  • Could have reduced inhibitors so more clot than normal
    o Protein c and s deficiency
    o Antithrombin III deficiency
47
Q

what deficiency can result in thrombophillia

A

o Protein c and s deficiency
o Antithrombin III deficiency

48
Q

what could happen if you have untreated thrombophillia

A

Clot can embolise and lead to blockage of major blood vessels in the heart and/or lungs
(Pulmonary thromboembolism)

49
Q

3 types of platelet disorders

A

Thrombocytopenia

Thrombocythemia

Qualitative disorder

50
Q

Thrombocytopenia vs Thrombocythemia

A

Thrombocytopenia = too little

Thrombocythemia = too many platelets

51
Q

penia = reduced

A
52
Q

causes of thrombocytopenia

A
  • Idiopathic
  • Drug related
  • Alcohol
  • Penicillin
  • Heparin
  • Leukaemia
  • Myelodysplasia
  • Bone marrow producing excessive numbers of red and white cells with no capacity to make platelets
53
Q

are the platelet function normal in thrombocytopenia and thrmbocythemia?

A

in thrombocytopenia, normal

in thrombocythemia, poor function

54
Q

what is Qualitative platelet disorder

A

Normal platelets numberbut Abnormal function

55
Q

causes of qualitative platelet disorders?

A
  • Inherited
  • Acquired
    o Cirrhosis
    o Drugs
    o Alcohol
    o cabg
56
Q
A

BDS2 BAMS (27 decks)

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