Coagulation - clinical

DVT prevention

• anti DVT stocking

• boots and leg compresison devices

• need to be aware if oral sedation + long procedures

• increases risk with birth control

activated partial thromoplastin time vs prothrombin time

• aPTT: intrinisc clotting pathway

• PT: extrinisc

vWD

• most common inherited bleeding disorder: 1%

• platelt adhesion secondary to deficinecy in vWF

• 1+2 mod, 3 sveere

hemophillia A

• most common coag factor disorder

• factor VIII

• can develop antibodies if treated with it

managment of patients with bleeding disorder

• good history

  • any history of bleeding or bruisng (check platelt count, PT, aPTT, or refer

• hisotry of bleeding in fam

• follow up who has excessive bleeding

• look for medications that could affect ability to clot

• contributing medical

  • liver disease, cancer, renal failure

surgical treatment like extractions require platlet count of at least

50,000: transfucsions can be used to elevate

• Hemophillia

  • for mild deficiencies in factor VIII

  • moderate deficiencies in factor VIII

  • severe in factor VIII

  • indudicle inhibitors

• DDAVO, transexamic acid, EACA

• Factor VIII replaceent, ^

• factor VIII replacement

• avoid elective surgery!

Patients with vWD

• midl type I and II

• Severe III

• DDAVP and EACA

• DDAVP and ECA + cyroprecipate, factor VIII concnetrates

other considerations

• good hygiene instruciton and aggresive maintence essential

• NO ASA OR NSAIDs

• for most routine dentoalvoelar surgeries: NSAIDS or platelt inhibitors?

• for patients on coumadin

• no need to take them off it

• find out INR past sev months

• Check INR morning of appoint: if < 3.2 safe

what do do with someone bleeding from extraciton site

• relax

• pressure (min of 10 mins, tea bags)

which can be used with thrombin

gel foam