SCD - haematology Flashcards
What should you ask for if a px is on warfarin
INR
What does INR stand for
international normalised ratio
What does INR test
prothrombin time aka time taken to clot
What does INR need to be before tx begins
<4
What guidance do you refer to if unsure how to tx a patient on warfarin
SDCE management of patients taking anticoagulants or anti platelet drugs
When should a patient have their last INR done before commencing tx
ideally within 24h
can be up to 72 if px is stable
What drugs potentiate warfarin
- Amiodarone
- Antibiotics
- Alcohol (if px has liver disease)
- NSAIDs
- flucanzole/miconazole
What drugs inhibit warfarin
- Carbamazepine
- Cholestyramine
- Griseofulvin
- Alcohol (without liver disease)
What antibiotic is high risk for warfarin interaction
metronidazole!
What antibiotics are low risk for warfarin
clindamycin
What are dental procedures that are unlikely to cause bleeding
- LA by infiltration, intraligamentary or mental nerve block
- LA by inferior dental block or other regional nerve block
- basic BPE
- supragingival removal of plaque, calculus and stain
- direct or indirect restorations with supragingival margins
- orthograde endo
- impressions and other prosthetic procedures
- fitting and adjustment of ortho appliances
What are dental procedures that are low risk of post-op bleeding complications
- simple extractions
- incision and draininage of intra oral swellings
- detailed 6PPC
- root surface instrumentation and subgingival scaling
- direct or indirect restorations with subgingival margins
What procedures are high risk for post-op bleeding complications
- complex extractions, extractions that will cause a large wound of extracting more than 3 teeth
- flap raising procedure
- gingival recountering
- biopsies
When should you change the dosing schedule for dental procedures?
only if the procedure is high risk
If a patient is on apixiban, and you are performing a high risk procedure, what changes should the px make to their dosing schedule
miss the morning dose pre treatment
take their usual dose in the evening
If a patient is on dabigatran, and you are performing a high risk procedure, what changes should the px make to their dosing schedule
same as apixiban
Miss morning dose pre treatment
Usual dose in evening
If a patient is on rivaroxaban, and you are performing a high risk procedure, what changes should the px make to their dosing schedule
if takes it in the morning → delay morning dose and take it 4 hours after treatment
Otherwise take it as normal
Patient has been booked in for a simple extraction of 25, she is on apixiban and she asks you if she should still take her medication leading up to it
she should take her medication as normal
this is not a high risk procedure because it is a simple extraction
it is classed as low risk
Patient is coming in to get her 26 restored. It is quite a difficult restoration as it extends subgingivally. She is on dabigatran.
She tells you that last time she came in to get some teeth out, the dentist told her to skip her morning dose and move it to the evening.
She asks you if she should do this again
No, there is no need
Restorations with subgingival margins are low risk
She should stick to her usual dosing schedule
New patient comes in, on taking a medical history and she tells you she previously had a heart attack and is now on aspirin, clopidogrel & rivaroxaban. She takes all her medications in the morning
You examine this patient and see this lesion. What will you do next in regard to this lesion and what will you tell the patient in regards to their medications
A biopsy will need to be taken
Biopsies are high risk procedures for post-operative bleeding
She should delay her morning dose and wait until 4 hours after the biopsy has been taken
A patient with stage 3 grade B generalised periodontitis comes in for their second re-evaluation post having done PMPR (professional mechanical plaque removal) twice.
The pockets are >4mm and there is bleeding on probing however the patient’s oral hygiene is good.
You decide the next step is surgical access.
The patient is on dabigatran, what should you tell her regarding her dosing schedule
surgical access would require a flap to be raised
flap raising procedures are high risk
therefore she should miss her morning dose pre treatment and take her usual evening dose
What is the advantages of new oral anti coagulants
- Predictable
- Short half life
- Less interactions than warfarin
- Generally, less need for lab monitoring
What are the disadvantages of new oral anticoagulants
- No standardised test for monitoring
- The short half life can be a bad thing
- Lack of antidote
- Quite new
What is haemophilia A
- factor 8 deficiency
