Warfarin INR Management — ORE Part 1 MCQ

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EasyHuman Disease & Dental ManagementWarfarin INR ManagementORE Part 1

A patient taking warfarin for previous deep-vein thrombosis requires a non-urgent dental extraction. Their INR, checked on the day of treatment, is 4.3. According to SDCEP guidance, what is the most appropriate management?

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Correct answer: A — Defer extraction until the INR has been reduced

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

A is correct. SDCEP advises that a patient taking warfarin may undergo dental treatment likely to cause bleeding without interrupting anticoagulation only if the INR is below 4. With an INR of 4.3, non-urgent extraction should be delayed until the INR has been reduced. If treatment were urgent, referral to secondary dental care would be appropriate. Local haemostatic measures, suturing and packing are important when treatment proceeds within the recommended INR range, but do not override the INR threshold (B). Dentists should not independently reduce or stop warfarin (C, D), because interruption can expose the patient to thromboembolic risk. A reassuring bleeding history does not negate an INR of 4.3 (E).

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition, section 6 (2022): https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf