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- 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