Factors Affecting The Rate Of Protein C ( An Anti Coagulation Factor )

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○ Factors V, VII, VIII, IX, X, XII.1,16,17
○ von Willebrand factor.16
○ Decreased levels of fibrinolytic protein C (an anti-coagulation factor).16
○ Coagulation changes are most pronounced in the third trimester.16
● Effect on Dental Treatment o The patient’s hypercoagulable state places them at increased risk for thromboembolic disease.17 Because of this, there is an increased risk that the patient may have a thromboembolism while in the dental office. (See the following section titled “Thromboembolic Disease” for additional information.)
Thromboembolic Disease
● Background Information
○ Changes in clotting factors place all pregnant women at increased risk for venous thromboembolism.8
○ During pregnancy, women have a five times
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○ The patient may be on anticoagulant therapy which may increase risk for bleeding.17
○ Epinephrine from local anesthetic during intramuscular injections is not thought to significantly increase risk. Accidental intravascular injection may increase risk of activating coagulation.16 (For further information see “Local Anesthetics – The Immediate Post Partum Period” on page …)
Antiphospholipid Syndrome (APLS)
● Background Information
○ APLS is a disease where antiphospholipid antibodies bind to phospholipids and may cause thrombosis and fetal loss.1,20
○ Women with APLS are at significant risk for thromboembolism during pregnancy. They may be placed on anticoagulant therapy to prevent thrombus formation.1,20
● Presentation in Dental Office
○ The patient may list the medical diagnosis, or medication being taken on the health history.
● Effect on Dental Treatment
○ Provide dental care to these patients in a hospital setting.1
Immune System (IgG)
● Background Information
○ In the second half of pregnancy, immunoglobulin G (IgG) blood levels are decreased.8
● Presentation in the Dental Office
○ Decreased IgG levels can lead to oral pathogen proliferation. This may allow for sustained oral infections such as periodontal disease.8
● Effect on Dental Treatment o Emphasize the importance of impeccable at-home oral hygiene care. (Refer to OHI see page ____)
Supine (“Frank”) Hypotensive Syndrome
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