Ticagrelor Emergency Extraction — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsTicagrelor Emergency ExtractionORE Part 1

A 55-year-old man on ticagrelor (90 mg twice daily) following acute coronary syndrome 6 weeks ago requires emergency dental extraction for an acute abscess. According to SDCEP guidance, what is the antiplatelet management?

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Correct answer: E — Continue ticagrelor without interruption; use local haemostatic measures

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

SDCEP guidance stipulates that antiplatelet therapy should not be interrupted except under direct written instruction from the prescriber. For ticagrelor post-acute coronary syndrome, the thrombotic risk of discontinuation significantly outweighs the bleeding risk from emergency dental extraction. The patient is only 6 weeks post-ACS, placing them at particular thrombotic risk. Management involves continuing the medication whilst employing local haemostatic measures: atraumatic technique, suturing, gauze packing, topical adrenaline in local anaesthetic, and post-operative instructions. Options B–E incorrectly advocate stopping or delaying antiplatelet therapy, which is contraindicated in this high-risk patient. Option E incorrectly delegates the decision to the cardiologist, when emergency dental care can safely proceed under haemostatic management with the drug continued.

Reference: SDCEP Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd Edition, 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf