Management of Haemostasis Disorders

ANTIPLATELET

Dr. Dineshwarran RajendranKlinik Pergigian Besar Kota Bharu

IntroductionHaemostasisA process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel.

Hemostasis has three major steps: 1) vasoconstriction2) temporary blockage of a break by a platelet plug 3) blood coagulation, or formation of a fibrin clot 

Haemostasis disorder A disorder which affects the normal heamostasis process which can lead to abnormal bleeding.

Steps in Haemostasis

1. Coagulation factor deficiencies

2. Platelet disorders • Quantitative disorder (thrombocytopenia)• Idiopathic• Drug-induced (Antiplatelet medication)• Collagen vascular disease• Sarcoidosis• Disseminated intravascular coagulation• Leukemia

• Qualitative disorder• Glanzmann thrombasthenia• von Willebrand’s disease• Drug-induced (Antiplatelet medication)• Liver disease

3. Vascular disorders

4. Fibrinolytic defects

Types of Heamostasis Disorders

Antiplatelet MedicationDefinitionA group of drugs that that decrease platelet aggregation and inhibit thrombus formation.

UsesPrevention and treatment of arterial thrombosisTreatment of established arterial thrombosis includes the use of antiplatelet drugs and thrombolytic therapy. Antiplatelet drugs alter the platelet activation at the site of vascular damage crucial to the development of arterial thrombosis.

Example of Antiplatelet drugs• Aspirin and Triflusal • Dipyridamole • Clopidogrel • Epoprostenol 

How do antiplatelet medications affect bleeding time?

The effect on primary haemostasis is minimal in patients without additional risk factors for impaired clotting. Antiplatelet medications can double the baseline bleeding time but this may still be within or just outside the normal range. It has been reported that only 20% to 25% of patients using aspirin have an abnormal bleeding time.

Antiplatelet medications DO NOT have to be stopped before primary care dental surgical procedures

Patients taking • low-dose aspirin (75mg-300mg daily) • clopidogrel • dipyridamole

should not have their medications stopped or altered prior to dental surgical procedures in primary care.

Dentists must be aware of the impact of bleeding disorders on the management of their patients. Proper dental and medical evaluation of patients is therefore necessary before treatment, especially invasive treatment. Patients should be queried about any previous unusual bleeding episode after surgery or injury, spontaneous bleeding and easy or frequent bruising.

A clinically significant bleeding episode is when:• continues beyond 12 hours• causes the patient to call or return to the dental practitioner or to seek medical treatment or

emergency care• results in the development of hematoma or

ecchymosis within the soft tissues or• requires blood transfusion

Patients taking antiplatelet medications will have a prolonged bleeding time but this may not be clinically relevant.Postoperative bleeding after dental procedures can be controlled using local haemostatic measures

Bleeding complications, while inconvenient, do not carry the same risks as thromboembolic complications.Patients are more at risk of permanent disability or death if they stop antiplatelet medications prior to a surgical procedure than if they continue it.Published reviews of the available literature advise that aspirin should not be stopped prior to dental surgical procedures.

Thank You.