Thrombophilia (congenital bleeding disorder) Flashcards
What is thrombophilia?
Increased risk of clots forming
What are the inherited causes of thrombophilia?
Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Factor V Leiden
What are acquired caused of thrombophilia?
Immobility; surgery, long flights Drugs; oral contraceptive pill Trauma; exaggerated/enhanced clotting Cancer Pregnancy Antiphospholipid syndrome
How is thrombophilia treated?
Anticoagulation medication
List the types of anticoagulation medication.
Oral anticoagulants
Heparins
Ant-Platelet drugs
Who should be given anticoagulants?
Those with; Thrombophilia Deep vein thrombosis Mechanical heart valves Heart valve disease A fibrillation
What is the biggest/most dangerous problem associated with thrombophilia?
Embolism
Name the oral anticoagulant drugs (old and new)
Standard - warfarin
New:
Rivaroxaban
Apixaban
Dabigatran
What is the daily dosage of warfarin?
1 - 15mg
Why are patients on warfarin monitored closely?
Unpredictable bioavailability
Lots of drug interactions
How are warfarinised patients monitored?
Using INR
What must you always do before prescribing medication to a patient taking warfarin?
seek advice from the GP
What is it safe to assume in a patient on warfarin?
That all medications interact
What drugs must you exercise caution with in a patient on warfarin?
Aspirin
Antibacterials
Antifungals ‘azole’ = fluconazole
What factors does warfarin inhibit?
Factor 2, 7, 9 and 10
Protein C and S
What happens when a patient starts warfarin?
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.
Name the new oral anticoagulants. What do they inhibit?
Inhibit factor Xa
Rivaroxaban
Apixaban
Inhibit thrombin directly
Dabigatran
What are the advantages of new anticoagulant drugs?
No monitoring required
Safer and cheaper
Predictable bioavailability
What should a patient on Warfarins INR be?
2-3
What are the two types of heparins?
Unfractioned
Low molecular weight
How are unfractioned heparins administered?
IV in hospital
How are low molecular weight heparins administered?
Via subcutaneous injection
Can be done at home
What type of heparin is easy to control and why?
Unfractioned - short half life
What heparin doesn’t need to be monitored?
Low molecular weight
List the anti-platelet medication (old and new)
Old:
Aspirin 75mg
Clopidogrel
New:
Prasugrel
Before which treatments should an anti coagulated patient have their INR checked?
Extractions, minor oral surgery, periodontal treatment and biopsies.
How long before treatment should the INR be checked?
48 - 24 hours before (48 is max, the sooner the better)
In terms of extraction in an anticoagulated patient; what is the maximum amount that can be extracted at one time?
3 roots
What local anaesthetics should be used in an anti coagulated patient?
LA containing vasoconstrictors
IDB with aspiration !! (different to haemophiliacs, they can’t)
Infiltration injections
Intraligamentary infiltrations
Mental infiltrations
What should an anticoagualted patients INR be to allow treatment to go ahead?
< 4
When should anti coagulated patients be treated?
In the morning
At the start of the week
Allows patient to come back and see you if there are any problems.
