XLA on Warfarin

Question 1

What is yellow book used for warfarin pt?

Answer 1

Every pt on warfarin has yellow anticoagulation record - explains what medication is for and doses and INR results

Question 2

What is warfarin?

Answer 2

Anticoagulant - prevent formation clots

Question 3

What is INR?

Answer 3

International normalised ratio - measure of how long blood takes to clot
Higher INR the longer the blood takes to clot

Question 4

What does INR of 2 mean?

Answer 4

Blood take 2 x longer than average to clot

Question 5

When would check INR prior to XLA?

Answer 5

INR < 24 hours procedure if high risk of bleeding
If pt has stable INR - extend 72 hours

Question 6

When is safe to proceed w/ XLA for pt on warfarin?

Answer 6

If between 2-4

Question 7

What to do if INR > 4

Answer 7

Defer XLA and ask pt to Lias w/ anticoagulation clinic for potential adjustment of warfarin dos

Question 8

Pt comes w/ INR of 5.1 - how to explain to pt unable to carry out xla?

Answer 8

Ensure pt is aware of why unable to proceed and why this is in his best interest
Prevent complications from uncontrolled bleeding
If ++ pain - extirpate tooth

Question 10

How to achieve haemostats in anti coagulated pt?

Answer 10

LA as temporary vasoconstrictor
Minimise trauma
Pack and suture
Compress using damp gauze - min 20 mins
Staged tx

Question 11

What other risks are there to pt w/ mechanical heat valves?

Answer 11

Increased risk of infective endocarditis

Question 12

What is infective endocarditis?

Answer 12

Bacterial infection of inner lining of heart chambers and valves
NICE does not recommend routine prophylaxis

Question 13

When would give prophylactic ab for IE?

Answer 13

Limited cases inc previous IE

Question 14

What are risks of long term steroid use?

Answer 14

Atrophy of gland causing adrenal insufficiency causing low levels of cortisol