Oral Surgery for the Medically Complex Patient

Question 1

Illnesses associated with bleeding problems.

Answer 1

• Leukemia
• Liver disease
• Hemophilia
• Congenital Heart Disease

Question 2

Different thromboplastin reagents have different sensitivities, resulting in widely varying what?

Answer 2

Prothrombin time

Question 3

This normalizes PT values no matter which thromboplastin is used to generate it.

Answer 3

INR

Question 4

High intensity protocol for anticoagulation.

Answer 4

Heart valve replacement

Question 5

Standard protocol for taking anticoagulants.

Answer 5

1) Atrial fibrillation
2) Myocardial infarction
3) Pulmonary embolism

Question 6

When a blood clot travels to the lung.

Answer 6

Pulmonary embolism

Question 7

An irreversible anti-platelet drug.

Answer 7

Aspirin

Question 8

A reversible anti-platelet drug.

Answer 8

NSAIDs

Question 9

Anti-platelet drugs.

Answer 9

Aspirin and NSAIDs

Question 10

The lifespan of a platelet

Answer 10

10 days.

Question 11

What did Dr. campbell’s research on antiplatelets and blood loss during oral surgery discover?

Answer 11

There was no difference in blood loss between those taking anti-platelets at the time of surgery, and those who stopped taking them 10 days before surgery.

Question 12

A structural analog of Vit. K

Answer 12

Coumadin

Question 13

Warfarin is active how many days after you last take it?

Answer 13

2-3 days.

Question 14

What does Warfarin inhibit?

Answer 14

Vit. K dependent extrinsic pathway.

Question 15

Factors affected in the extrinsic pathway.

Answer 15

2, 7, 9, and 10.

Question 16

Do Warfarin patients bleed more than those who don’t take Warfarin?

Answer 16

NO!

Question 17

Directly inhibits Thrombin

Answer 17

Pradaxa

Question 18

This patient is on Eliquis/Apixaban

Answer 18

Margaret

Question 19

Another name for Eliquis

Answer 19

Apixaban

Question 20

Newer anti-coagulant that prevents DVT.

Answer 20

Xarelto

Question 21

This can complicate bleeding after an operation.

Answer 21

Post-perative infection

Question 22

Consider giving this after an operation to avoid post-operative infection that can complicate bleeding.

Answer 22

Antibiotic prophylaxis

Question 23

This injection increases your chances of having a bleeding problem.

Answer 23

Block

Question 24

Contains activated Thrombin to control bleeding.

Answer 24

GelFoam

Question 25

Used to rinse the wound to control bleeding.

Answer 25

5% Transexemic acid

Question 26

Used to control bleeding that’s coming from the bone.

Answer 26

GelFoam or Bone wax

Question 27

Controls bleeding that’s coming from the tissue.

Answer 27

Surgicel

Ligation

Cautery

Question 28

When do you refer patients?

Answer 28

When you can’t provide as good a standard of care as a specialist would.