IE Prophylaxis Prosthetic Valve — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsIE Prophylaxis Prosthetic ValveORE Part 1

A patient with a surgically implanted prosthetic mitral valve, taking warfarin, requires extraction of a tooth. According to current SDCEP implementation advice, what is the appropriate approach to infective endocarditis antibiotic prophylaxis?

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Correct answer: B — Offer prophylaxis and discuss its benefits and harms with the patient

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

A is correct. A surgically implanted prosthetic mitral valve places the patient in SDCEP’s high-risk group. For high-risk patients undergoing a dental extraction, SDCEP advises that antibiotic prophylaxis should be offered, with shared discussion of its potential benefits and harms before prescribing. Warfarin treatment and the INR affect planning for bleeding risk, but do not determine infective endocarditis prophylaxis eligibility. B misstates NICE: CG64 says prophylaxis is not recommended routinely, but specifically signposts the UK-endorsed SDCEP advice for high-risk dental patients. C and D use irrelevant criteria; neither INR nor use of general anaesthesia determines the indication. E is unnecessarily restrictive: cardiology input may be useful if clinical information is unclear, but it is not a prerequisite to offering prophylaxis in this defined high-risk extraction scenario.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Antibiotic Prophylaxis Against Infective Endocarditis: Implementation Advice, 2nd edition, Executive summary, March 2026. https://www.antibioticprophylaxis.sdcep.org.uk/implementation-advice/executive-summary/executive-summary/