Special Care - Haematology

Question 1

how do you calculate INR?

Answer 1

Prothrombin time / reference PT plasma

Question 2

what is the INR value of a healthy individual?

Answer 2

1

Question 3

when should INR values be taken before extracting a tooth in an individual with poorly controlled health?

Answer 3

within 24 hours before

Question 4

what INR value is required for extraction?

Answer 4

LESS THAN 4

Question 5

In relation to INR readings, what factors influence our decision? (3)

Answer 5

INR values

Frequency of testing

variance

Question 6

when should INR values be taken before extracting a tooth in an individual with stable health?

Answer 6

up to 72 hours

Question 7

at what time in the week/day should you extract teeth in anti-coagulated patients?

Answer 7

Early in the week

Early in the morning

Question 8

describe LA techniques in anti coagulated patients. (4)

Answer 8

use vasoconstrictors

infiltration or intraligamentary where possible

short needles minimise tissue damage

avoid blocks but use aspirating technique if necessary

Question 9

what are the advantages of new oral anticoagulants ie the use of warfarin? (6)

Answer 9

predictable

require less monitoring

no INR before treatment

rapid onset

less drug interactions

no dietary restrictions as low food interactions

Question 10

Describe the mechanisms of action for the NOAC’s apixaban and rivoroxiban.

Answer 10

Factor Xa inhibitor

Question 11

what procedure cannot be carried out on patients with haemophilia in the GDP setting? (5)

Answer 11

extractions

surgical procedure

sub gingival scaling

IAN blocks

lingual infiltrations

Question 12

what do we give patients with mild haemophilia before procedures which will likely cause bleeding?

Answer 12

DDAVP

Question 13

what do we give patient with moderate/severe haemophilia before procedures which will likely cause bleeding?

Answer 13

factor replacement

Question 14

Describe our approach to treatment in those with haemophilia if they are receiving factor replacement.

Answer 14

Try to get as much done as possible in each appointment as replacing factors carries risks;

• quadrant approach
• do all of the right side in one appointment etc

Question 15

what should the platelet count be for extraction if a tooth in a primary care setting/GDP?

Answer 15

100 x 10(power of 9)/L

Question 16

what platelet count indicates that the tooth would have to be extracted in a secondary care setting/hospital?

Answer 16

50 x 10(power of 9)/L

anything between 50-100 = liaise with haematologist