Term
| Bleeding associated with dentistry |
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Definition
1. Surgery and Trauma
2. Tooth extraction
3. Perio. therapy
4. Vital pulpal exposure |
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Term
| What can make bleeding abnormal? |
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Definition
1. Duration
2. Volume Lost
3. Extra treatment required |
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Term
|
Definition
| The prevention of blood loss |
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Term
|
Definition
1. Vascular spasm
2. Platelet plug formation
3. Blood coagulation
4. Growth of fibrous tissue |
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Term
|
Definition
1. Prevents excessive blood loss
2. Smooth muscle in the vessel wall contracts
3. Vessel diameter reduced |
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Term
| Formation of platelet plug mechanism |
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Definition
1. Platelet adhesion
2. Platelet release action
3. Platelet aggregation |
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Term
|
Definition
| Platelets detect damage to a blood vessel and adhere to damaged surface |
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Term
| 2. Platelet release action |
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Definition
| Once stuck platelets begin to change. First create extensions to communicate. Second release their contents- this stimulates nearby platelets and cause vasoconstriction |
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Term
|
Definition
| Platelets become sticky and adhere to each other. Creates a platelet plug which stops the loss of blood through small holes in vessels |
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Term
| Two clotting cascade pathways |
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Definition
Intrinsic - blood plasma
Extrinsic - tissue damage |
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Term
| Intrinsic pathway initiator |
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Definition
|
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Term
| Extrinsic pathway initiators |
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Definition
|
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Term
| What is prothrombin (factor II) converted to? |
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Definition
|
|
Term
| What effect does thrombin have on fibrinogen? |
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Definition
| Converts fibrinogen to fibrin monomers which can then make fibrin polymers |
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Term
| What roles does factor XIII have? |
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Definition
| Creates covalent bonds between fibrin polymers which then create a cross linked fibrin meshwork |
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Term
| What activates prothrombin? |
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Definition
|
|
Term
| What increases the effect of Factor X? |
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Definition
| Factor V - positive feedback loop |
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Term
|
Definition
| Factors III, TF-VIIa and IXa |
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|
Term
Effects of blood loss?
Tissues
Stomach |
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Definition
|
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Term
| What does reduced blood volume cause? |
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Definition
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Term
| Tests of bleeding function for warfarin? |
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Definition
| INR - international normalised ratio |
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Term
| Test of bleeding function for heparin? |
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Definition
| APTT - activated partial thromboplastin time |
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Term
|
Definition
| Plasminogen converted to plasmin which degrades fibrin clot. Degredation products when endocytosed by macrophages |
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|
Term
|
Definition
| Prevents the action of vitamin K. Prevents carboxylation of clotting factor precursors |
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Term
|
Definition
| Required for production of Factors 2, 7, 9 and 10 in the liver |
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|
Term
| Effect of anitbiotics on warfarin |
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Definition
| Enhances effect of warfarin |
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|
Term
| Clotting factor half lives |
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Definition
|
|
Term
| Time taken for warfarin to take effect |
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Definition
|
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Term
| Reasons for patients on warfarin |
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Definition
1. Heart valve abnormalities
2. Thromboembolytic disease
3. Atrial fibrillations
4. Cardiac/vascular abnormalities |
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|
Term
| When is blood INR taken in warfarin protocol? |
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Definition
|
|
Term
| What is the determining INR value? |
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Definition
|
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Term
|
Definition
| Proceed with surgery using any neccessary antibiotics and LA |
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|
Term
| After surgical extraction? |
|
Definition
| Place surgicel in pocket with layer of Vicryl Rapide on top. Then keep for 30 minutes |
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Term
| After 30 minutes following surgical extraction? |
|
Definition
| Check if bleeding stopped. If not apply further local measures. If stopped bring back in one week for review. |
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Term
|
Definition
| Irreversibly binds to platelets. Inactivates COX required for thromboxane A2 mediated aggregation |
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Term
|
Definition
| Binds to platelets reversibly |
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|
Term
|
Definition
Same as warfarin
Where platelet aggregation (thrombi) likely to occur in vascular systyem |
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|
Term
| Antifibronolytic drugs use |
|
Definition
| Haemophilliacs to back up factor VII replacement |
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|
Term
| Use for warfarin patients? |
|
Definition
| Effective as a mouthwash for heamostasis in warfarin anticoagulant patient for XLA |
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|
Term
| Implications of antifibrinolytic effectiveness |
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Definition
| That fibrinolysis is an important factor in prolonged bleeding |
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