Prasugrel Urgent Extraction — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsPrasugrel Urgent ExtractionORE Part 1

A patient taking aspirin and prasugrel is 2 months after coronary stent placement. They require an urgent single-tooth extraction to drain an acute dental abscess. What is the most appropriate management?

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Correct answer: C — Extract without interrupting either drug; use local haemostatic measures

**A is correct.** SDCEP recommends treating patients on single or dual antiplatelet therapy **without interrupting** their medication; this is especially important for a patient with a coronary stent. Undertake the urgent extraction atraumatically, preferably early in the day, and secure haemostasis before discharge using local measures such as pressure, haemostatic packing and suturing. Prolonged bleeding can occur with dual therapy but is usually manageable locally. **B** risks serious thromboembolic events, including stent thrombosis. **C** is inappropriate because changing antiplatelet treatment is a cardiology/prescriber decision and does not improve dental management. **D** is not a routine requirement; seek medical advice only if clinical details require clarification. **E** is inappropriate because antibiotics alone do not provide definitive treatment or drainage of an odontogenic abscess when extraction is indicated.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd Edition, Section 8: Treating a Patient Taking an Antiplatelet Drug(s), March 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf