SC- haematology

Question 1

What is the INR and when is it taken?

Answer 1

International normalised ratio which shows the patient’s level of control of the medication. (to show bleeding time)

This is taken 24 hours before treatment or <72 hours in patients who are stable.

Question 2

Discuss what we need to know before deciding to treat a warfarin patient?

Answer 2

• INR <4
• That their INR has been stable for the last 2 months. (not >4)
• That they do not require weekly monitoring for their INR.

Question 3

What can cause variance in INR level?

Answer 3

• Bad warfarin control
• Alcohol and juice
• Stress
• Change in lifestyle
• sickness
• Medications (antifungals and antibiotics)
  *

Question 4

When would you need to change the dosage of a patient’s NOAC?

Answer 4

If the patient is undergoing treatments with a high bleeding risk.

Question 5

Give examples of treatments with a higher risk of post-operative bleeding complications.

Answer 5

Complex extractions (Adjacent extractions that will cause a large wound or more than 3 extractions at once.

Flap raising procedures (e.g. implant surgery/Periodontal surgery/Dental implants)

Biopsies.

Gingival recontouring.

Question 6

Discuss an Apixaban’s drug schedule and how you would change it to accomodate treatment.

Answer 6

drug schedule (twice a day)

Miss first dose and only take at nightime (ensure 4 hours after haemostasis has been acheived)

Question 7

Discuss a patient on Dabigatran’s drug schedule and how you would change it to accomodate treatment.

Answer 7

drug schedule (twice a day)

Miss first dose and only take at nightime (ensure 4 hours after haemostasis has been acheived)

Question 8

Discuss an patient on Rivaroxaban’s drug schedule and how you would change it to accomodate treatment.

Answer 8

Drug schedule: once a day.

If taken in the morning- postpone it to 4 hours after haemostasis.

If patient takes it at night- have it at normal time (ensure 4 hours after haemostasis)

RivOroxaban.- for Once

Question 9

How do we treat a patient who has had a STEMI and why?

Answer 9

We wait 6 months before treating them as they will be on an aspirin and an anti-coagulant.

Question 10

What do we need to achieve before discharging patients on antiplatelets or anticoagulants.

Answer 10

Haemostasis.

Question 11

What must you do with haemophilia patients before starting any treatment?

Answer 11

Contact their haemophilia doctor to obtain their blood test results.

Question 12

What treatments for a haemophilia patient can you do in a GDP?

Answer 12

Examination.

Supragingival restorations/ crowns/ bridges.

Treatments that do not manipulate the mucosa.

Infiltration anaesthesia.

Question 13

What treatments should you refer haemophilia patients for treatment?

Answer 13

Extractions

Surgical procedures

Subgingival scaling.

Anaesthesia (IANB/ Lingual infiltration)

Question 14

What cover would be used for patients with mild haemophilia

Answer 14

DDAVP

Question 15

What cover would be used for patients with Von willebrand’s

Answer 15

DDAVP

Question 16

What cover would be used for patients with moderate (2-5% of factor present)

Answer 16

Factor replacement

Haemophilia A- replace factor 8.

Hameophilia B- replace factor 9

Question 17

What cover would be used for patients with severe (<1%) factor present.

Answer 17

Factor replacement

For haemophilia A- Factor VIII

For haemophilia B- Factor IX.