Thrombophilia (congenital bleeding disorder)

Question 1

What is thrombophilia?

Answer 1

Increased risk of clots forming

Question 2

What are the inherited causes of thrombophilia?

Answer 2

Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Factor V Leiden

Question 3

What are acquired caused of thrombophilia?

Answer 3

Immobility; surgery, long flights
Drugs; oral contraceptive pill
Trauma; exaggerated/enhanced clotting 
Cancer 
Pregnancy 
Antiphospholipid syndrome

Question 4

How is thrombophilia treated?

Answer 4

Anticoagulation medication

Question 5

List the types of anticoagulation medication.

Answer 5

Oral anticoagulants
Heparins
Ant-Platelet drugs

Question 6

Who should be given anticoagulants?

Answer 6

Those with;
Thrombophilia 
Deep vein thrombosis 
Mechanical heart valves 
Heart valve disease
A fibrillation

Question 7

What is the biggest/most dangerous problem associated with thrombophilia?

Answer 7

Embolism

Question 8

Name the oral anticoagulant drugs (old and new)

Answer 8

Standard - warfarin

New:
Rivaroxaban
Apixaban
Dabigatran

Question 9

What is the daily dosage of warfarin?

Answer 9

1 - 15mg

Question 10

Why are patients on warfarin monitored closely?

Answer 10

Unpredictable bioavailability

Lots of drug interactions

Question 11

How are warfarinised patients monitored?

Answer 11

Using INR

Question 12

What must you always do before prescribing medication to a patient taking warfarin?

Answer 12

seek advice from the GP

Question 13

What is it safe to assume in a patient on warfarin?

Answer 13

That all medications interact

Question 14

What drugs must you exercise caution with in a patient on warfarin?

Answer 14

Aspirin
Antibacterials
Antifungals ‘azole’ = fluconazole

Question 15

What factors does warfarin inhibit?

Answer 15

Factor 2, 7, 9 and 10

Protein C and S

Question 16

What happens when a patient starts warfarin?

Answer 16

Initially there is hypercoagulation so patient must be hospitalised and given IV heparins until the warfarin adjusts. Patient can then be taken off the heparins.

Question 17

Name the new oral anticoagulants. What do they inhibit?

Answer 17

Inhibit factor Xa
Rivaroxaban
Apixaban

Inhibit thrombin directly
Dabigatran

Question 18

What are the advantages of new anticoagulant drugs?

Answer 18

No monitoring required
Safer and cheaper
Predictable bioavailability

Question 19

What should a patient on Warfarins INR be?

Answer 19

2-3

Question 20

What are the two types of heparins?

Answer 20

Unfractioned

Low molecular weight

Question 21

How are unfractioned heparins administered?

Answer 21

IV in hospital

Question 22

How are low molecular weight heparins administered?

Answer 22

Via subcutaneous injection

Can be done at home

Question 23

What type of heparin is easy to control and why?

Answer 23

Unfractioned - short half life

Question 24

What heparin doesn’t need to be monitored?

Answer 24

Low molecular weight

Question 25

List the anti-platelet medication (old and new)

Answer 25

Old: Aspirin 75mg Clopidogrel New: Prasugrel

Question 26

Before which treatments should an anti coagulated patient have their INR checked?

Answer 26

Extractions, minor oral surgery, periodontal treatment and biopsies.

Question 27

How long before treatment should the INR be checked?

Answer 27

48 - 24 hours before (48 is max, the sooner the better)

Question 28

In terms of extraction in an anticoagulated patient; what is the maximum amount that can be extracted at one time?

Answer 28

3 roots

Question 29

What local anaesthetics should be used in an anti coagulated patient?

Answer 29

LA containing vasoconstrictors IDB with aspiration !! (different to haemophiliacs, they can't) Infiltration injections Intraligamentary infiltrations Mental infiltrations

Question 30

What should an anticoagualted patients INR be to allow treatment to go ahead?

Answer 30

< 4

Question 31

When should anti coagulated patients be treated?

Answer 31

In the morning At the start of the week Allows patient to come back and see you if there are any problems.