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SURGERY and diseases

Discussion in 'Graduate Studies' started by aayisha quddus, Dec 8, 2014.

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  1. aayisha quddus

    aayisha quddus Member

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    Oral Surgery & Warfarin
    The risk of significant bleeding in patients on Warfarin
    low.Patients on Warfarin might bleed more than normal but
    bleeding is easily treated with 'local measures' (packing the
    tooth-socket with material that aids blood-clotting and
    stitching of the tooth socket).

    Warfarin should NOT be discontinued in the majority of
    patients requiring dental extractions and biopsies unless
    instructed otherwise by their Anticoagulant Clinic.

    There is an increased risk of thrombosis in patients who
    have temporarily stopped taking their Warfarin (the risk is
    small but potentially fatal). Bleeding complications, while
    inconvenient, do not carry the same risks as thrombo-
    embolic
    complications (that can lead to permanent
    disability or death).
    Treatment Algorithm for Warfarinised Patients (British Dental Journal 2003)
    Please click here to send any comments via email.


    Anti-Platelet Drugs & Oral Surgery
    An increasing number of patients are taking “blood thinners
    for various medical conditions.

    These drugs interfere with the body’s normal clotting
    mechanism. There are 2 main processes by which the body
    normally forms a blood clot at the site of tissue injury.

    The 1st involves small blood cells called platelets which
    clump together at the wound to form a mechanical plug. Thisplug slows the flow of blood through the vessel and forms a
    matrix for the next phase of coagulation. During coagulation,
    chemicals in the blood interact with each other to fill in the
    spaces between the platelets, stabilise the clot, & make it
    more solid until the process stops the bleeding.

    Anti-platelet drugs such as aspirin, ticlopidine & clopidogrel
    target this phase of clot formation by preventing platelets
    from sticking together and adhering to blood vessels. These
    drugs do this by creating permanent changes in the platelets
    which last for the lifetime of the platelet (7 - 10 days). These
    effects can only be countered as the body produces new platelets that have not been exposed to the drug.

    Anti-coagulant agents such as warfarin inhibit the 2nd phase
    of clotting by blocking production of proteins that stabilise
    the clot. Warfarin can only affect these blood proteins when
    they are being made.

    Hæmophilia & Von Willebrand's
    Disease & Oral Surgery

    Patients with Hæmophilia (Factors VIII & IX
    Deficiencies
    ) & Von Willebrand's Disease
    Hæmophilia is a group of hereditary genetic disorders that
    impair the body's ability to control coagulation (blood
    clotting).Hæmophilia A (Clotting Factor VIII deficiency) is the most
    common form of the disorder (1 in 5,000 – 10,000 male
    births).Hæmophilia B (Clotting Factor IX deficiency) is rarer than Hæmophilia A, occuring in around 1 in about 20,000 –
    34,000 male births.Hæmophilia lowers blood plasma clotting factor levels of
    the coagulation factors needed for normal coagulation.
    When a blood vessel is injured, a clot does form but the
    missing coagulation factors prevent fibrin formation, which is
    necessary to maintain the blood clot.

    A hæmophiliac does not bleed more intensely than a person
    without it but can bleed for a much longer time. In severe
    cases, even a minor injury can result in bleeding that can last
    days - weeks or there is incomplete healing. In areas such
    as the brain or inside joints, this can be fatal or permanently
    debilitating.

    Rare Clotting Factor Deficiencies
    & Oral Surgery

    Patients with Rare Clotting Factor Deficiencies
    Clotting / Coagulation Factors are proteins in the blood that
    control bleeding.

    If any of the clotting factors are deficient or defective, the coagulation cascade is blocked. When this happens, the
    blood clot does not form & bleeding continues longer than it
    should.

    Rare clotting factor deficiencies are bleeding disorders in
    where clotting factors other than those of Factors VIII & IX
    (otherwise known as Hæmophilias) are deficient / defective.

    These are Factors I, II, V, VII, X, XI, XII & XIII.

    Rare Clotting Factor Deficiencies
    & Oral Surgery

    Patients with Rare Clotting Factor Deficiencies
    Clotting / Coagulation Factors are proteins in the blood that
    control bleeding.

    If any of the clotting factors are deficient or defective, the coagulation cascade is blocked. When this happens, the
    blood clot does not form & bleeding continues longer than it
    should.

    Rare clotting factor deficiencies are bleeding disorders in
    where clotting factors other than those of Factors VIII & IX
    (otherwise known as Hæmophilias) are deficient / defective.

    These are Factors I, II, V, VII, X, XI, XII & XIII.

    Platelet Disorders & Deficiencies
    & Oral Surgery

    Patients with Platelet Disorders & Deficiencies
    Platelets are cell fragments that function in the clotting / coagulation system.Platelets circulate for 7 - 10 days. About one third are
    always transiently sequestered in the spleen.

    The platelet count is normally 140,000 - 440,000/μL.
    However, the count can vary slightly according to menstrual
    cycle phase, decrease during near-term pregnancy
    (gestational thrombocytopænia) & increase in response to
    inflammatory cytokines (secondary or reactive
    thrombocytosis
    ).Platelets are eventually destroyed, primarily by the spleen.Platelet disorders include:
    • Abnormal increase in platelets (thrombocythæmia)
    • Decrease in platelets (thrombocytopænia)
    • Platelet dysfunction

    Any of these conditions, even those in which platelets are
    increased, may cause defective formation of hæmostatic
    plugs
    & bleeding.

    The risk of bleeding is inversely proportional to the platelet
    count
    .

    When the platelet count is < 50,000/μL, minor bleeding
    occurs easily & the risk of major bleeding increases.

    Counts between 20,000 - 50,000/μL predispose to bleeding
    with trauma, even minor trauma.

    With counts < 20,000/μL, spontaneous bleeding may occur.

    With counts < 5000/μL, severe spontaneous bleeding is
    more likely.

    However, patients with counts < 10,000/μL may be
    asymptomatic for years.

    Dialysis PatientsThe degree to which kidney, liver & bone marrow disease
    interfere with coagulation following oral surgical procedures
    is not well understood. Although there are no randomised,
    prospective studies, it is unlikely that individuals whose
    kidney failure is well managed with dialysis would be at
    increased risk for clinically significant bleeding, even from
    multiple dental extractions.

    In the case of dialysis for Chronic Renal Failure, patients areheparinised for the time they are receiving dialysis, & they
    could be anti-coagulated to some degree for several hours
    thereafter.Heparinisation, along with chronic anti-coagulation (eg aspirin, warfarin), creates a multi-factorial coagulopathy
    that puts a patient at higher risk for bleeding from oral
    surgical procedures immediately following dialysis.
    Although the half-life of heparin is approximately 4 hours, dialysis is a long & fatiguing procedure, & for this reason
    patients are better able to tolerate dental care on a non-dialysis day. On the other hand, the longer a patient is
    from their last dialysis, the more likely they are to have a coagulopathy from uræmia
     
  2. Softgrip

    Softgrip New Member

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    Softgrip New Member

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  4. zahra1234

    zahra1234 Member

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    thanks for sharing
     
  5. zahra1234

    zahra1234 Member

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    thanks for sharing
     
  6. Ahsan Abbas

    Ahsan Abbas New Member

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    Your Post Is To much Informative.
    I shall be greatfull upone this act of you.................
     
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