Warfarin and Dental Extractions — MFDS Part 1 MCQ

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ModeratePharmacologyWarfarin and Dental ExtractionsMFDS Part 1

A patient taking warfarin requires a simple dental extraction. Their INR has been checked within the interval recommended by SDCEP and is stable. According to current SDCEP guidance, below which INR value may extraction generally proceed without interrupting warfarin, using appropriate local haemostatic measures?

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Correct answer: A — INR below 4.0

The correct answer is A: INR below 4.0. SDCEP advises that patients taking warfarin or another vitamin K antagonist can undergo dental treatment likely to cause bleeding without interrupting anticoagulation when the INR is less than 4. Appropriate local haemostatic measures should be used; for extraction this includes measures such as packing and, where indicated, suturing. The INR should ideally be checked within 24 hours, or within 72 hours if it is stable. If the INR is 4.0 or above, invasive treatment should be delayed until it is reduced to below 4, with urgent cases referred to secondary care. Thresholds of 3.0, 2.0 and 1.5 are unnecessarily restrictive, while below 5.0 would wrongly permit treatment at INR 4.0 or above.

Reference: Scottish Dental Clinical Effectiveness Programme. Dental Companion: Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs — “Warfarin or another Vitamin K antagonist” (2nd edition guidance, 2022). https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/warfarin-or-another-vitamin-k-antagonist/