In this Slide we will talk about coagulation Disorders in periodontics in detail Also discuss about anticoagulant,antiplatelet And Thrombocytopenic purpura treatment and laboratory tests etc.

1. Coagulation Disorders
1. Inherited: Hemophilia A
Christmas disease
von Willebrandis Disease
2. Acquired: Liver disease
Vitamin K deficiency
Anticoagulation drugs
(heparin, coumarin)
Anemia

2. Evaluation of bleeding disorders
1. Take history
2. Physical examination
3. Screening clinical laboratory tests
4. Observation of excessive bleeding following a surgical
procedure

3. History
• Bleeding problems in relatives
• Bleeding problems following operations and tooth
extractions, trauma
• Use of drugs for prevention of coagulation or pain
• Spontaneous bleeding from nose mouth etc..

4. Physical Examination
• Jaundice
• Petechiae: <0.2 cm
• Purpura: 0.2 cm-1 cm
• Eccymoses : >1 cm
• Spider angioma
• Oral ulcer
• Hyperplasia of gingiva
• Hemarthrosis

5. Screening laboratory tests
• 1. Platelet count
• 2. BT (Bleeding Time)
• 3. PT (Prothrombin Time)
• 4. aPTT (active Partial Thrombopastin Time)
• 5. TT (Thrombin Time)

6. Anticoagulant (Heparin)
• Complex inhibited ( IXa, Xa, Xla, XIla)
• Used in deep vein thrombosis, renal dialysis > Rapid
onset, Duration 4-6hrs (given IV)
• Monitoring by aPTT: 50-65 sec
• Discontinue 6 hrs before surgery then reinstituting
therapy 6-12hrs post-op

7. Antiplatelet (Asprin)
• Inhibit cycloxygenase, TXA2 formation!
• Analgesic drug impairs platelet function
• Arterial thrombosis, MI
• Tests-BT, aPTT
• If tests are abnormal, MD should be consulted
before dental surgery is done
• Stop aspirin for 5 days, substitute alternative drug
in consultation with MD

8. Thrombocytopenic purpura
• Thrombocytopenic purpura is a blood disorder
characterized by an abnormal decrease in the number of
platelets in the blood
• This disease is caused by an immune reaction against one's
own platelets. It has also been called autoimmune
thrombocytopenic purpura.
• A decrease in platelets can result in easy bruising, bleeding
gums, and internal bleeding

9. Treatment
Platelet count of <20,000 is an indication of
treatment. 20,000-50,000 patients are
monitored. >50,000 treatment is not necessary.
• • Steroids i.e prednisone.
• Immunoglobulins (IgG).
• Anti-D administration.
• • Thrombopoietin Rececptor agonists are available.
Romiplostim & Eltrombopag.
• Surgery (splenctomy).
• Antibiotics used for the treatment of Helicobacter.pylori.
• Platelet transfusion.

10. Non Thrombocytopenic purpura
• Nonthrombocytopenic purpuras result from either vascular wall
fragility or thrombasthenia .
• Vascular wall fragility may result from hypersensitiv- ity
reactions, scurvy, infections, chemicals (phenacetin and
aspirin), dysproteinemia, and other causes.
• Thrombasthenia occurs in uremia, Glanzmann disease, aspirin
ingestion, and von-Willebrand disease
• Both types of nonthrombocytopenic purpura may result in

11. Treatment
1) Treatment consists primarily of direct pressure
applied for at least 15 min.
2) This initial pressure should control the bleed- ing
unless coagulation times are abnormal or reinjury
occurs.
3) Surgical therapy should be avoided until the
qualitative and quantitative platelet problems are
resolved.