DOAC Management — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementDOAC ManagementORE Part 1

A patient takes edoxaban once daily each morning. They require a complex surgical extraction with flap elevation, scheduled for the morning. Provided local haemostasis is achieved, how should the edoxaban dose be managed on the day of treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Delay the morning dose; take it 4 hours after haemostasis

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

**A is correct.** A surgical extraction with flap elevation is a higher-risk dental procedure for post-operative bleeding. SDCEP advises a patient taking once-daily morning edoxaban to delay, rather than omit, that morning dose. Once local haemostasis has been achieved, the delayed dose may be taken 4 hours later; the next dose is then taken at the usual time the following morning. B unnecessarily prolongs interruption of anticoagulation. C is the approach for procedures with a low risk of post-operative bleeding complications, not this procedure. D is excessive interruption for routine outpatient dental management and is not SDCEP advice. E is unsupported: DOAC doses should not be empirically reduced.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition: “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/