Cirrhosis Pre-Op Coagulation — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementCirrhosis Pre-Op CoagulationORE Part 1

A patient with Child-Pugh class B cirrhosis requires several dental extractions. They are not taking anticoagulant or antiplatelet medication. Which pre-operative step is most important?

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Correct answer: D — Assess bleeding risk and obtain relevant medical advice

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

A is correct. Cirrhosis can increase post-extraction bleeding risk through reduced hepatic coagulation-factor production and thrombocytopenia or platelet dysfunction. UK SDCEP guidance therefore advises assessing the likely bleeding risk and consulting the patient’s GP or specialist, where necessary, to establish disease severity and its procedural implications. Relevant investigations may be requested through the medical team, but an abnormal INR or platelet count should not automatically prompt correction: INR alone poorly predicts procedural bleeding in cirrhosis, and dental bleeding is usually manageable with local measures. A chest radiograph, glucose result, renal function alone, or allergy history alone may be relevant in selected patients, but none addresses the principal cirrhosis-specific pre-operative risk.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition, section 3.2.2 and Table 2, 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf