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DOAC Dental Management — MFDS Part 1 MCQ

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ModeratePharmacologyDOAC Dental ManagementMFDS Part 1

A 68-year-old patient takes apixaban 5 mg twice daily for stable non-valvular atrial fibrillation. They require the routine extraction of one erupted tooth, expected to be straightforward without flap raising and with a restricted wound size. They have no additional medical conditions, medications or bleeding history that increase bleeding risk. What is the most appropriate anticoagulant management according to current UK dental guidance?

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

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Correct answer: E — Continue usual apixaban dosing and secure haemostasis using local measures

A straightforward extraction of one tooth with a restricted wound is classified by SDCEP as having a low risk of postoperative bleeding complications. Apixaban should therefore be continued without missing or delaying a dose. Treatment should be planned early in the day, the initial treatment area limited, and haemostasis achieved before discharge using local measures; packing and suturing should be strongly considered. Omitting the morning apixaban dose, as in D, is reserved for procedures with a higher risk of bleeding complications, such as complex or surgical extraction. Stopping treatment for 48 hours creates an unnecessary period of reduced anticoagulation. Bridging with low-molecular-weight heparin and conversion to warfarin are not recommended for routine dental extraction and would introduce avoidable complexity and risk.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition. Table 1 and sections 4.1 and 5.1. 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf