Anticoagulant Management — ORE Part 1 MCQ

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HardOral SurgeryAnticoagulant ManagementORE Part 1

A patient taking apixaban (a DOAC) twice daily requires dental extraction. According to SDCEP guidance, how should the morning dose on the day of the procedure be managed?

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Correct answer: C — Miss the morning dose on the day of the procedure

Explanation lettering: C = shown as A · A = shown as C

SDCEP 2022 guidance differentiates DOAC management by bleeding risk of the dental procedure. Extractions are classified as higher bleeding-risk procedures. For apixaban (and dabigatran) taken twice daily undergoing higher-risk dental procedures, SDCEP advises the patient to miss the morning dose on the day of treatment, then resume the usual evening dose at normal time. This balances minimising perioperative anticoagulation while allowing time to manage any bleeding complications within surgery hours. Option B (take as usual) applies only to low-risk procedures. Options C, D, and E are not supported: SDCEP does not recommend 48-hour interruption, early dosing, or heparin bridging for routine dental procedures.

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/direct-oral-anticoagulants-doacs/recommendations/