Anticoagulant Management — ORE Part 1 MCQ

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ModerateOral SurgeryAnticoagulant ManagementORE Part 1

A 55-year-old man taking warfarin requires extraction of the upper right second premolar. His INR, checked 24 hours before the procedure, is 3.2. What is the most appropriate action?

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Correct answer: E — Proceed with extraction using local haemostatic measures without stopping warfarin

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

SDCEP guidance explicitly recommends treating patients on warfarin with INR <4 without interrupting anticoagulation. With INR 3.2 (checked appropriately 24 hours prior), this patient meets criteria for uninterrupted treatment. Option A is correct: proceed using local haemostatic measures (pressure, packing, suturing, tranexamic acid if needed). Options B–E represent common but incorrect approaches: cancellation is unnecessary (B); stopping warfarin increases thromboembolic risk and contradicts SDCEP (C); bridging with LMWH is reserved for major surgery, not routine extractions, and risks heparin-induced complications (D); dose halving is not evidence-based and provides uncertain benefit (E). The discriminator is understanding that simple dental extractions are managed by haemostatic control, not by interrupting anticoagulation.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs (2nd Edition), 2022. https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/warfarin-or-another-vitamin-k-antagonist/