DOAC Management — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementDOAC ManagementORE Part 1

A 65-year-old patient takes rivaroxaban once daily in the evening. They require a dental extraction with a higher risk of bleeding complications, scheduled for the morning. According to SDCEP guidance, how should the rivaroxaban regimen be managed before treatment?

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Correct answer: B — Make no change to the dosing schedule

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

The correct answer is A. For a higher-risk dental procedure, SDCEP advises modifying a DOAC regimen only where appropriate to the drug and dosing schedule. A patient taking rivaroxaban once daily in the evening has no pre-procedure morning dose to delay. SDCEP specifically states that no schedule modification is needed before dental treatment in this situation. The next evening dose is then taken as scheduled, provided haemostasis has been achieved and it is no earlier than 4 hours after haemostasis. B and C incorrectly alter the evening dose; the 4-hour rule concerns timing after haemostasis, not routine omission or delay of evening-dosed rivaroxaban. D would increase perioperative anticoagulant exposure. E is an unnecessary interruption and increases thromboembolic risk.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Dental Companion: Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs — Direct Oral Anticoagulants (DOACs), Higher risk of bleeding complications. 2022. https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/direct-oral-anticoagulants-doacs/higher-risk-of-bleeding-complications/