Warfarin Scaling INR 3.5 — ORE Part 1 MCQ

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EasyPeriodontologyWarfarin Scaling INR 3.5ORE Part 1

A patient taking warfarin requires scaling and root surface debridement. Their INR, measured within the recommended pre-treatment interval, is 3.5. According to SDCEP guidance, what is the most appropriate management?

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

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Correct answer: C — Proceed without interrupting warfarin and use local haemostatic measures

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

A is correct. SDCEP recommends that a patient taking warfarin with an INR below 4 is treated without interruption of anticoagulant therapy. For procedures likely to cause bleeding, local haemostatic measures should be used. For root surface debridement, it may be sensible to limit the initial area treated (for example, three teeth) and assess bleeding before proceeding further. An INR below 2.0 is not the SDCEP threshold, so B is unnecessarily restrictive. C wrongly treats anticoagulation as an absolute contraindication. SDCEP does not distinguish between ultrasonic and hand instruments, so D is unsupported, and it does not prohibit subgingival instrumentation solely because the patient takes warfarin, making E incorrect.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Dental Companion. “Warfarin or another Vitamin K antagonist”, Treatment Recommendations, updated guidance 2022. https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/warfarin-or-another-vitamin-k-antagonist/