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My BDS2 > Thrombophilia (congenital bleeding disorder) > Flashcards

Thrombophilia (congenital bleeding disorder) Flashcards

1
Q

What is thrombophilia?

A

Increased risk of clots forming

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2
Q

What are the inherited causes of thrombophilia?

A

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

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3
Q

What are acquired caused of thrombophilia?

A 
Immobility; surgery, long flights
Drugs; oral contraceptive pill
Trauma; exaggerated/enhanced clotting 
Cancer 
Pregnancy 
Antiphospholipid syndrome
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4
Q

How is thrombophilia treated?

A

Anticoagulation medication

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5
Q

List the types of anticoagulation medication.

A

Oral anticoagulants
Heparins
Ant-Platelet drugs

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6
Q

Who should be given anticoagulants?

A 
Those with;
Thrombophilia 
Deep vein thrombosis 
Mechanical heart valves 
Heart valve disease
A fibrillation
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7
Q

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

A

Embolism

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8
Q

Name the oral anticoagulant drugs (old and new)

A

Standard - warfarin

New:
Rivaroxaban
Apixaban
Dabigatran

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9
Q

What is the daily dosage of warfarin?

A

1 - 15mg

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10
Q

Why are patients on warfarin monitored closely?

A

Unpredictable bioavailability

Lots of drug interactions

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11
Q

How are warfarinised patients monitored?

A

Using INR

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12
Q

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

A

seek advice from the GP

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13
Q

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

A

That all medications interact

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14
Q

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

A

Aspirin
Antibacterials
Antifungals ‘azole’ = fluconazole

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15
Q

What factors does warfarin inhibit?

A

Factor 2, 7, 9 and 10

Protein C and S

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16
Q

What happens when a patient starts warfarin?

A

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.

17
Q

Name the new oral anticoagulants. What do they inhibit?

A

Inhibit factor Xa
Rivaroxaban
Apixaban

Inhibit thrombin directly
Dabigatran

18
Q

What are the advantages of new anticoagulant drugs?

A

No monitoring required
Safer and cheaper
Predictable bioavailability

19
Q

What should a patient on Warfarins INR be?

A

2-3

20
Q

What are the two types of heparins?

A

Unfractioned

Low molecular weight

21
Q

How are unfractioned heparins administered?

A

IV in hospital

22
Q

How are low molecular weight heparins administered?

A

Via subcutaneous injection

Can be done at home

23
Q

What type of heparin is easy to control and why?

A

Unfractioned - short half life

24
Q

What heparin doesn’t need to be monitored?

A

Low molecular weight

25
Q

List the anti-platelet medication (old and new)

A

Old:
Aspirin 75mg
Clopidogrel

New:
Prasugrel

26
Q

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

A

Extractions, minor oral surgery, periodontal treatment and biopsies.

27
Q

How long before treatment should the INR be checked?

A

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

28
Q

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

A

3 roots

29
Q

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

A

LA containing vasoconstrictors

IDB with aspiration !! (different to haemophiliacs, they can’t)
Infiltration injections
Intraligamentary infiltrations
Mental infiltrations

30
Q

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

A

< 4

31
Q

When should anti coagulated patients be treated?

A

In the morning
At the start of the week

Allows patient to come back and see you if there are any problems.

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