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Rivaroxaban Morning Dose Management — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementRivaroxaban Morning Dose ManagementORE Part 1

A patient with controlled atrial fibrillation takes rivaroxaban 20 mg once daily in the morning. They require three simple dental extractions. According to SDCEP guidance, which management plan is most appropriate?

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

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Correct answer: B — Delay the morning dose; treat early, secure haemostasis, then take the dose after 4 hours

**A is correct.** SDCEP classifies three extractions as a procedure with a higher risk of post-operative bleeding complications. For rivaroxaban taken once daily in the morning, advise the patient to delay that morning dose. Carry out treatment early in the day, use local haemostatic measures—strongly considering suturing and packing—and only discharge once haemostasis is achieved. The delayed dose can then be taken no earlier than 4 hours after haemostasis; the following dose is taken at the usual time the next morning. A planned 3-day interruption, heparin bridging, and dose reduction are not SDCEP dental strategies and unnecessarily alter anticoagulation. Continuing the morning dose would be appropriate for a low-risk procedure, but not for the higher-risk extraction scenario described.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition, Section 5.2, 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf