Post-Extraction Bleeding Warfarin — ORE Part 1 MCQ

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ModerateOral SurgeryPost-Extraction Bleeding WarfarinORE Part 1

A 60-year-old patient taking warfarin has an INR of 3.1. Following extraction of the lower left second premolar, persistent oozing continues despite initial gauze pressure. What is the most appropriate next management step?

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Correct answer: E — Pack the socket with oxidised cellulose and suture it

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

Answer: A. An INR of 3.1 is within the SDCEP threshold for treating without interrupting warfarin (INR below 4). Persistent oozing despite initial gauze pressure requires escalation to local haemostatic management: haemostatic packing, such as oxidised cellulose, and suturing are specifically recommended measures. The patient should not be discharged until haemostasis has been achieved. B is inadequate because initial pressure has already failed. C unnecessarily alters anticoagulation and exposes the patient to thromboembolic risk. D is inappropriate for controlled dental socket bleeding in a patient with a therapeutic INR and would reverse anticoagulation. E is not the recommended definitive local approach; packing and suturing provide mechanical stabilisation of the clot. Routine tranexamic-acid mouthwash prescribing is not advised by SDCEP in primary dental care.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs: Warfarin or another Vitamin K antagonist; Haemostatic measures. 2nd edition, 2022. https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/warfarin-or-another-vitamin-k-antagonist/