Medications that impact bleeding

By Nino LalaiantsInesa LegrianNYCCT 2012

Some Dental Procedures Associated with Bleeding

Dental prophylaxisScaling and root planning Periodontal surgeryTooth extractionsDental implant placementBiopsies

Aspirin-acetylsalicylic acid •Antiplatelet agent•Prevention and treatment of myocardial infraction•Treatment for postoperative pain•Bleeding is dose related•MOA – COX-1 and COX-2 inhibitor

NSAID’sMedications: Ibuprofen,

ketoprofen, Flurbiprofen, and Napronex

Prototype drug: IbuprofenNSAID’s reduce thrombaxaneIncrease risk of bleeding when

used with warfarin, or antiplatelet drugs

TMD, Rheumatoid and Osteoarthritis

diclofenac (Voltaren)

Plavix-Clopidogrel

Antiplatelet agentReduces possible

myocardial infraction, stoke

Primary prevention against stent thrombosis

Warfarin - Coumadin

AnticoagulantNarrow therapeutic index drug Prophylaxis and treatment of

thromboembolic disorders Prolonged and spontaneous bleeding Interferes with synthesis of Vitamin K

dependant factors: II, VII, IX, XAntibiotics increase levels of warfarinPresence of petechiae or little

hemorrhage spots on hard palate

Petechiae in hard palate

Heparin - IV

AnticoagulantProphylaxis and

treatment of thromboembolic disorders

Adverse effect – internal bleeding, including bleeding from the gums.

LovenoxLower molecular

weight heparinTreatment of

Deep Vein Thrombosis with and without Pulmonary Embolism

Bleeding is a major adverse effect

Impact on dental hygiene TreatmentRelaxed and composedBlood thinner may be longer still

possess necessary clotting factors

Communicate with patients’ MDPatient must know their INR level

(INR<3.5)

Q.1

Excessive amount of what Vitamin can decrease levels of Warfarin?a. Vit. Bb. Vit. Kc. Vit. Cd. Vit. A

Q. 2

Antibiotics can increase levels of Warfarin. Warfarin dose should be reduced by dental hygienist prior the dental treatment.a. Both statements are true.b. Both statements are false.c. First statement is true. Second

statement is false.d. First statement is false. Second

statement is true.

Q. 3

Aspirin is used fora. Painb. Cardiovascular diseasec. Unstable anginad. All of the above

Q.4

What is the drug interaction between aspirin and NSAIDs?a. Increase bleedingb. Decrease bleedingc. None of the above