Haematology Flashcards

1
Q

What is warfarin?

A
  • anticoagulant
    • vitamin K antagonist
    • 48-72 hours for full anticoagulant to develop
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2
Q

What is INR and what levels are acceptable in dentistry?

A
  • blood test used to calculate the INR ratio
    • prothrombin time divided by reference plasma value
  • INR of 1 for a healthy individual
  • 2-4
  • any invasive treatment must have an INR of under 4
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3
Q

What drug is used if an immediate anticoagulant effect is needed?

A
  • low molecular weight heparin
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4
Q

What are direct-acting oral anticoagulants?

A
  • DOACs
    • apixiban
    • dabigatran etexilate
    • edoxaban
    • rivaroxaban
  • regular monitoring not required as with warfarin
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5
Q

What does dabigatran etexilate act on?

A
  • reversible inhibitor of free thrombin, fibrin-bound thrombin and thrombin induced platelet aggregation
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6
Q

What do apixiban, edoxaban and rivaroxaban act on?

A
  • reversible factor Xa inhibitors
    • prevent thrombus development
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7
Q

What is simvastatin?

A
  • lipid lowering medication
    • HMG CoA reductase inhibitor
  • treats hypercholesterolaemia
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8
Q

What is furosemide?

A
  • loop diuretic
    • can exacerbate diabetes (less than thiazide diuretics)
  • controls hypertension
    • combined with other hypertension medications
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9
Q

What antifungals can be prescribed with warfarin?

A

-nystatin
- safe for use in warfarin patients

  • -azole antifungals must be avoided
    • potentiates the anticoagulant effect
    • increased risk of myopathy when taking statins
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10
Q

When is an INR required before performing dental treatment?

A
  • no more than 24 hours before the procedure
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11
Q

How is haemostasis achieved after extraction from a warfarinised patient?

A
  • local anaesthetic
    • containing vasoconstrictor
    • short, 27 gauge needle to minimise tissue damage
  • local haemostasis
    • pack sockets with absorbable haemostat dressing
    • place sutures (ideally resorb ably_
    • pressure applied by patient biting on gauze
    • atraumatic technique for extraction
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12
Q

What should a patient taking apixaban be told before having an extraction?

A
  • to change their drug regime prior to treatment
    • miss morning dose
    • take usual evening dose (4 hours after homeostasis achieved)
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13
Q

What is haemophilia A?

A
  • factor VIII deficiency
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14
Q

What is haemophilia B?

A
  • factor IX deficiency
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15
Q

What are the different severities of haemophilia?

A

mild - 6-40% factor present
moderate - 2-5% factor present
severe - <1% factor present

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16
Q

What dental treatments must be performed at haemophilia centres for haemophiliacs?

A
  • extractions
  • surgical procedures
  • sub gingival scaling
  • procedures requiring IDB or lingual infiltration
  • any procedure manipulating the mucosa
17
Q

What drug can be used for mild haemophilia or Von Willebrand’s patients undergoing dental procedures at increased risk of bleeding?

A
  • DDVAP
    • desmopressin acetate
18
Q

What is required for patients with moderate and severe haemophilia patients undergoing dental procedures at increased risk of bleeding?

A
  • factor replacement
  • tranexamic acid
19
Q

What is used to manage Von Willebrand’s type 2?

A
  • factor VIII concentrate