SDCEP management of dental patients taking anticoagulants or antiplatelet drugs Flashcards
Give examples of dental procedures that are unlikely to cause bleeding?
- LA infiltration and block
- BPE
- supragingival PMPR
- restorations with
- supraginigval margins
- impressions
- ortho appliances
What are examples of dental procedures that are likely to cause bleeding on a low risk scale?
- simple extraction (eith restricted wound size)
- incision and drainage of intraoral 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 (more than 3 , adjacent extractions)
- flap raising procedures
- biopsies
- gingival recontouring
In a patient taking warfarin, what do you require to have before giving an idb?
INR below 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 and function due to splenomegaly
- alcohol excess can result in direct bone marrow toxicity
and reduced platelet number s
Give examples of medical conditions which have an increased bleeding?
- chronic renal failure
- liver disease
- haematological malgnancy
recent or current chemotherapy or radiotherapy (within 3 months for chemo , 6 months for radiotherapy) - haemophilia , von willbrand’s
- advanced heart failure
- connective tissue disorders
- platelet disrders
Why do patients of chemotherapy and 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 drugs can be associated with increased bleeding risks?
- anticoagulants
- antiplatelets
-cytotoxic drugs - biological imunosuppression therapies
- NSAIDs
- SSRI and anti epileptics
When assessing a patient bleeding risk , what things should you consider?
- current use of anticoagulant or antiplatelet drugs
- ask about any medical conditions
- ask about bleeding history
What local measures should be considered for achieving haemostasis in patients with high risk bleeding?
- absorbant gauze
- haemostatic packing material (oxidised cellulose or collagen sponge)
- suturing
How do DOAC and warfarin differ? and why is this relevant?
- DOACs = rapid onset and short half life
- to modify an individual anticoagulation status rapidly
How many times is apixaban taken ?
twice , morning and evening
how many times is dabigatran taken?
twice
how many times is rivaroxaban taken?
once
how many times a day is edoxaban taken?
once
A patiient enters you practice 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 does
what other measures should be taken in high bleeding risk pts on DOAC
- plan treatment early in day or week
- limit initial treatment area and 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 you can treat them without interrupting their medication?
INR below 4 (within 72hours is acceptable but prefer 24h)
Your patient INR level is >4 but they require-emergency treatment what do you do ?
refer to secondary care
A patient is taking a single /dual antiplatelet drugs how should they be managed?
treat without interreupting medication
Examples antiplatelets
-aspirin
- clopidegrol
- dipyridamole
- prasugrel
- ticagrelor
- theyinhibit thrombus formation
How to treat a patient on anticoagulant/anti-platelet combination
consult with the patient’s prescribing clinician to assess the impact of this
