Urgent DAPT Extraction — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementUrgent DAPT ExtractionORE Part 1

A 65-year-old woman requires extraction of a tooth causing an acute dental abscess. She has taken aspirin 75 mg and clopidogrel 75 mg daily for 3 months following insertion of a drug-eluting coronary stent. Her cardiologist cannot be contacted. What is the most appropriate management?

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Correct answer: C — Extract the tooth, continue both drugs, and use sutures and packing

The extraction should proceed without interrupting aspirin or clopidogrel, with local haemostasis, including packing and strong consideration of suturing. SDCEP makes a strong recommendation to treat patients taking dual antiplatelet therapy without interruption: bleeding may be prolonged but is usually controllable locally. In contrast, interruption of dual antiplatelet treatment after coronary stenting carries a risk of serious thromboembolic cardiac events; SDCEP stresses that it must not be stopped prematurely or without cardiologist advice. Therefore, stopping both drugs or clopidogrel alone is unsafe. Deferral is inappropriate where urgent source control is required for an acute abscess. Antibiotics alone do not remove the dental source and are not a substitute for operative drainage or extraction when indicated.

Reference: Scottish Dental Clinical Effectiveness Programme. Dental Companion: Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs—Antiplatelet drugs (key recommendations and clinical practice advice), 2022 recommendation. https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/antiplatelet-drugs/