Liver Disease and Bleeding — MFDS Part 1 MCQ

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ModerateHuman DiseaseLiver Disease and BleedingMFDS Part 1

A patient with established liver cirrhosis requires a dental extraction. Which cirrhosis-related haematological change most directly increases the risk of post-extraction bleeding?

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Correct answer: C — Reduced coagulation-factor production with thrombocytopenia or platelet dysfunction

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

The correct answer is A. Cirrhosis can reduce hepatic production of coagulation factors and, through portal hypertension and splenomegaly, reduce platelet number and function. These abnormalities increase concern about haemostasis following extraction and require assessment of disease severity, bleeding history and relevant investigations, with medical advice where appropriate. Cirrhotic haemostasis is complex rather than simply anticoagulated: factor VIII may be increased and thrombosis can occur, so an isolated prolonged PT/INR does not reliably predict procedural bleeding. Nevertheless, options D and E incorrectly imply otherwise normal haemostasis or absence of a clinically relevant bleeding tendency. Thrombocytosis and polycythaemia are not the characteristic extraction-related concerns.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd Edition, sections 3.2.2 and Table 2, 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf