SDCEP Management of Dental Patients Taking Anticoagulant or Antiplatelet Drugs Flashcards
Give examples of dental procedures are unlikely to cause bleeding?
- LA infiltration/block
- BPE
- supragingival PMPR
- restorations with supragingival margins
- impressions
- fitting/adjusting orthodontic appliances
What are examples of dental procedures that are likely to cause bleeding on a low risk scale?
- simple extractions (1-3 teeth, with restricted wound size)
- incision & drainage of intra-oral swellings
- detailed 6PPC
- root surface debridement
- restorations with subgingival margins
What are examples of dental procedures that are likely to cause bleeding on a high risk scale?
- complex extractions (>3 extractions, or adjacent extractions that will cause large wound)
- flap raising procedures
- gingival recontouring
- biopsies
In a patient taking warfarin, what do you require to have before giving an IDB?
INR level
- ensure <4
Why do patients with chronic renal failure have an increased bleeding risk?
associated platelet dysfunction
Why do patients with liver disease have an increased bleeding risk?
- reduced production of coagulation factors
- reduction in platelet number & function due to splenomegaly
- alcohol excess can result in direct bone marrow toxicity & reduced platelet numbers
Give examples of medical conditions which have an increased risk of bleeding?
- chronic renal failure
- liver disease [caused by alcohol, hepatitis etc.]
- haematological malignancy
- recent or current chemotherapy or radiotherapy [within 3 months for chemo, 6 months for radiotherapy]
- haemophilia / von Willebrand’s
- advanced heart failure
- connective tissue disorders
- platelet disorders
Why do patients with recent or current chemotherapy/radiotherapy have an increased bleeding risk?
Pancytopenia including reduced platelet numbers
Why do patients with advanced heart failure have an increased bleeding risk?
resulting liver failure
What drug groups can be associated with increased bleeding risks?
- anticoagulants
- antiplatelets
- cytotoxic drugs
- biologic immunosuppression therapies
- NSAIDs
- SSRIs & anti-epileptics
When assessing a patients bleeding risk, what things should you consider?
- current use of anticoag/antiplatelet drugs [is it lifelong or limited time]
- ask about any medical conditions
- ask about bleeding history
What local measures should be used to assist with haemostasis after treatment of high risk bleeding patients?
- absorbant gauze
- haemostatic packing material (oxidised cellulose, collagen sponge)
- suture kit
How do DOACs and Warfarin primarily differ? Why is this relavant?
DOACs = rapid onset (1-4 hrs) & short half lives (max 18hrs)
- Possible to modify an individuals anticoagulation status rapidly
How many times a day is Apixaban taken?
twice (morning & evening)
How many times a day is Dabigatran taken?
twice (morning and evening)
How many times a day is Rivaroxaban taken?
once
How many times a day is Edoxaban taken?
once
A patient enters your practise and they are taking a DOAC, the procedure is low-risk, how do you manage them?
Treat without interrupting medication
A patient enters your practise and they are taking a DOAC, the procedure is high-risk, how do you manage them?
Apixaban/Dabigatran = miss morning dose
Edoxaban/Rivaroxaban = delay morning dose
In addition to altering anticoagulant medications, what other measures should be undertaking to lower risk of bleeding complications?
- plan treatment early in day/week
- limit initial treatment area & assess bleeding before continuing
- use local haemostatic measures [suturing etc]
When should patients restart their anticoagulant medication after a procedure with a higher risk of bleeding?
4 hours after treatment
What INR level should a patient taking warfarin have so that you are able to treat them without interrupting their medication?
INR below 4 [within 72 hours is acceptable but prefer 24 hrs]
Your patients INR level is >4, but they require emergency treatment, what should you do?
Refer to secondary care
A patient is taking single/dual antiplatelet drugs, how should they be managed before treatment?
treat without interrupting their medication
