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Acquired Coagulation Defects

Dr. Adarsh K. Desai

What r acquired coagulation defects


Acquired coagulation defects are much prevalant than congenital diseases. Important causes:
1) anticoagulant therapy 2) vitamin k deficiency or malabsorption. 3) liver disease (deficiency of factor 7) 4) DIC disseminated intravascular coagulation ) 5) fibrinolytics states 6) Amyloidosis (def of factor 10) 7) Autoimmune disorders (def of factor 8)

Anticoagulant treatment
Most commonly used anticoagulants are Coumarins- long term warfarin - short term heparin Most comonly prescribed in thromboembolic diseases like - Atrial fibrillation - Cerebral thrombosis - deep vien thrombosis - embolization secondary to M.I. - heart valve replacement - Renal dialysis Anticoagulants results in a bleeding tendencies but generally post op haemorrhage which subsides spontaneously ..but severe blood loss can occur.

Coumarins such as warfarins are given orally .they antagonises the action of Vitamin K. So PT( prothombin time) & aptt (activated partial prothrombin time) are prolonged The effects are delayed for 8-12 hrs max 36 hrs but persist for 72 days (3days) Oral anticoagulants are teratogenic They should maintain a PT of 2 2 times of control ie 11-15 sec control (35 seconds) Pt is now recorded by INR (international normalized ratio) A ratio of 2-3 is usual theraupectic for deep vein thrombosis & upto 4.5 for patient with prosthetic heart valve

Heparin is not given orally but by injection and acts immediately mainly by inhibiting the thrombin fibrinogen reaction. PT, APTT, TT are prolonged Platelet count should be monitored if heparin used for more than 5 days since thrombocytopenia can result. Heparin effect usually last for 6 hrs or less. Low molecular heparin : dalteparin, enoxaparin , tinzaparin. Have longer duration of action. No interference should be done to anticoagulant therapy without agreement of clinican in charge. Neglect can lead to rebound thrombosis which has damaged prosthetic cardiac valves and even thromotic deaths.

Dental management of patients on oral coumarin anticoagulants


PT is standard lab test to monitor oral anti coagulant therapy activity. Citrated blood is tested by adding calcium & tissue thromboplastin to activate clotting cascade. The PT is expressed as the ratio of patients PT/ control value As control value & thromboplastin varies between laboratories which leads to different meanings of pt so INR was devised . INR is valid only on pts on stable anticoagulant therapy In which the a interational reference thromboplastin type 67/40 is used INR 0.9 1.2 is normal

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