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Uncontrolled DOAC Bleeding — ORE Part 1 MCQ

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ModerateOral SurgeryUncontrolled DOAC BleedingORE Part 1

A patient taking a direct oral anticoagulant has persistent, excessive bleeding after a dental extraction. Appropriate local measures, including pressure, socket packing and suturing, have not achieved haemostasis. The DOAC was managed appropriately in accordance with SDCEP guidance. What is the most appropriate next step?

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Correct answer: C — Arrange urgent emergency-care assessment for uncontrolled bleeding

**A is correct.** Persistent bleeding despite pressure, packing and suturing is uncontrolled in the primary-care setting and requires urgent emergency assessment. SDCEP advises that dental teams must know local emergency-care arrangements for the rare situation in which bleeding cannot be controlled in primary care; anticoagulated patients whose bleeding fails to stop should seek emergency care. Hospital assessment enables resuscitation where necessary, senior haemostatic management and consideration of DOAC-specific reversal pathways for major bleeding. Vitamin K reverses vitamin K antagonists such as warfarin, not DOACs. An additional DOAC dose would worsen anticoagulation. Sending the patient home for ongoing pressure, or simply persisting with pressure alone after appropriate local measures have already failed, inappropriately delays escalation.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd Edition (2022), section 4 Managing Bleeding Risk: https://www.sdcep.org.uk/media/efmfgy44/sdcep-anticoagulants-guidance.pdf