Valproate Dental Bleeding Risk — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementValproate Dental Bleeding RiskORE Part 1

A patient taking sodium valproate requires a surgical dental extraction. Which potential drug-related issue is most relevant to planning treatment?

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Correct answer: D — Thrombocytopenia and reduced platelet aggregation

Sodium valproate may cause thrombocytopenia and impair platelet aggregation, making bleeding history and haemostatic risk relevant before an extraction. The UK SmPC specifically recommends a blood cell count, platelet count, bleeding time and coagulation tests before surgery. This does not mean that valproate should be stopped routinely; rather, unexpected bruising, bleeding or a relevant history should prompt assessment and liaison with the prescriber. Gingival overgrowth is classically associated with phenytoin, although rare cases with valproate have been reported, so it is not the principal expected answer. Valproate does not inactivate all local anaesthetics, and enamel hypoplasia is a developmental defect rather than an acquired adult adverse effect.

Reference: electronic Medicines Compendium. Depakote 500 mg Tablets: Summary of Product Characteristics, sections 4.4 and 4.8, updated 2025. https://www.medicines.org.uk/emc/product/6113/smpc