Week 6 - Anticoagulants & Dentistry Flashcards

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1
Q

which medical conditions can predispose individuals to risk of thrombosis (with potential for heart attack, pulmonary embolism or stroke)

A
  • atherosclerosis

- cardiac arrhythmias

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2
Q

anticoagulants - prescribed to reduce the risk of thrombosis in patients with what conditions?

A
  • vascular/thromboembolic conditions
  • cardiac arrhythmias
  • history of stroke
  • following heart valve replacement surgery
  • cardiac stents
  • joint replacement
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3
Q

anticoagulants - dental aspects?
reduced risk of thromboembolic events comes at the cost of an increased risk in what?

what should be the consideration for these patients in their management?

A
  • comes with an increased tisk of bleeding spontaneously or bleeding associated with invasive procedures
  • balance risks and benefits for the patient that requires dental treatment
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4
Q

anticoagulant treatment: most commonly used anticoagulants are?

A
  • warfarin
  • antiplatelet drugs
  • novel oral anticoagulants (NOAC)
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5
Q

warfarin - what is it an antagonist to?

A

vitamin k

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6
Q

warfarin: how does it inhibit coagulation? takes how long for anticoagulant effect to develop? action reversible by?

A
  • it inhibits coagulation by antagonizing vitamin K
  • takes at least 48-72 hours
  • reversible by vitamin k
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7
Q

what are the limitations of warfarin?

A
  • narrow therapeutic range
  • sensitivity to diet
  • drug interactions
  • requires frequent monitoring and dose adjustment
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8
Q

warfarin - monitoring:
overall effect of oral anticoagulants can be measured by?
what is the normal range for prothrombin time?

A
  • can be measured by the International Normalized Ratio (INR) test which is the prothrombin time ratio
  • INR approx. 1
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9
Q

INR above 1 indicates what?

A

that clotting will take longer than normal

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10
Q

general management of warfarin: what is the information required prior to examination?

A
  • INR needs to be accessed 72 hours before procedure
  • INR stable: see BNF definition
  • INR should be below 4
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11
Q

what is the definition of a stable INR?

A
  • patient does not require weekly monitoring

- INR has not been above 4 the past two months

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12
Q

warfarin: management

when is the ideal time to check patient’s INR before treatment?

A
  • ideally 24 hours before procedure, but if INR stable can be up to 72 hours
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13
Q

warfarin: management?

what to do if patient’s INR above 4?

A
  • inform patient’s GMP or anticoagulation service
  • delay treatment
  • if urgent -> refer to secondary dental care
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14
Q

warfarin: management during treatment

- how should treatment be modified? x3

A
  • limit initial treatment area
    e. g. carry out single extraction first, limit scaling and RSD to limited area to access potential for bleeding
  • suturing over socket with an absorbable haemostatic dressing is essential
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15
Q

local anaesthetic - is considered it risky? why?

A
  • no

- because it is unlikely to cause bleeding

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16
Q

advice should be sought from GMP or anticoagulant clinic if?

A
  • unstable INR
  • INR >4 in last 2 months
  • other disorders of haemostasis
  • renal failure, liver disease or alcoholism
  • patient receiving cytotix drugs or radiotherapy
17
Q

interactions with warfarin: drugs that increase warfarin activity?

A
  • antibacterials
  • antiepileptics
  • antifungals
  • hormones
  • cardiac drugs
  • analgesics
18
Q

interactions with warfarin: drugs that decrease warfarin activity?

A
  • antiepileptics
  • antifungals: nystatin
  • cardiac drugs
  • analgesics
  • others e.g. oral contraceptives
19
Q

warfarin: effects can also be influenced by what?

A
  • irregular tablet taking
  • diets high in vitamin k
  • alcohol ingestion
  • cranberry juice (enhances effects)
20
Q

antiplatelet drugs: name 2 examples?

A
  • aspirin

- clopidogrel

21
Q

antiplatelet drugs: aspirin prescribed for?

A
  • prophylaxis of cerebrovascular disease
  • MI
  • can also be self-prescribed
22
Q

antiplatelet drugs: clopidogrel used for?

A
  • used in conjunction with low dose long term aspirin
23
Q

novel oral anticoagulants:
name examples?
example of when to use?
requires anticoagulant monitoring?

A
  • rivaroxaban, apixaban, dabigatran
  • prophylaxis of venous thromboembolism in adults after hip/knee replacement surgery
  • does not require anticoagulant monitoring
24
Q

general advice for patients taking anticoagulants or antiplatelet drugs?

A
  • plan treatment for early in the day and week
  • use appropriate local measures
  • only discharge patient when haemostasis achieved
  • place particular emphasis on measures to avoid complications (esp when travel time is far)
  • provide post treatment advice and emergency contact details