Download Medications-that-impact-bleeding

Medications that impact
bleeding
By Nino Lalaiants
Inesa Legrian
NYCCT 2012
Some Dental Procedures
Associated with Bleeding
Dental prophylaxis
 Scaling and root planning
 Periodontal surgery
 Tooth extractions
 Dental implant placement
 Biopsies

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’s
Medications: Ibuprofen, ketoprofen,
Flurbiprofen, and Napronex
 Prototype drug: Ibuprofen
 NSAID’s reduce thrombaxane
 Increase risk of bleeding when used with
warfarin, or antiplatelet drugs
 TMD, Rheumatoid and Osteoarthritis
diclofenac (Voltaren)

Plavix-Clopidogrel
Antiplatelet agent
 Reduces possible
myocardial infraction,
stoke
 Primary prevention
against stent
thrombosis

Warfarin - Coumadin







Anticoagulant
Narrow therapeutic index drug
Prophylaxis and treatment of
thromboembolic disorders
Prolonged and spontaneous bleeding
Interferes with synthesis of Vitamin K
dependant factors: II, VII, IX, X
Antibiotics increase levels of warfarin
Presence of petechiae or little
hemorrhage spots on hard palate
Petechiae in hard palate
Heparin - IV
Anticoagulant
 Prophylaxis and
treatment of
thromboembolic
disorders
 Adverse effect –
internal bleeding,
including bleeding from
the gums.

Lovenox
Lower molecular
weight heparin
 Treatment of Deep
Vein Thrombosis with
and without
Pulmonary Embolism
 Bleeding is a major
adverse effect

Impact on dental hygiene Treatment
Relaxed and composed
 Blood thinner may be longer still possess
necessary clotting factors
 Communicate with patients’ MD
 Patient must know their INR level
(INR<3.5)

Q.1
Excessive amount of what Vitamin can
decrease levels of Warfarin?
a. Vit. B
b. Vit. K
c. Vit. C
d. 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 for
a. Pain
b. Cardiovascular disease
c. Unstable angina
d. All of the above
Q.4
What is the drug interaction between
aspirin and NSAIDs?
a. Increase bleeding
b. Decrease bleeding
c. None of the above