Rivaroxaban Dental Extraction — MFDS Part 1 MCQ
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Correct answer: A — Continue rivaroxaban at the usual dose; treat early in the day, assess bleeding as treatment proceeds, and use local haemostatic measures
Explanation lettering: E = shown as C · C = shown as E
A is correct. SDCEP classifies straightforward extraction of one to three teeth with restricted wound size as a procedure with a low risk of postoperative bleeding complications. Rivaroxaban should therefore be continued without missing, delaying or reducing a dose. Treatment should be planned early in the day, the initial treatment area should be limited with bleeding assessed before continuing, and haemostasis must be secured using local measures; packing and suturing should be strongly considered. SDCEP explicitly notes that an early appointment may coincide with relatively high drug levels but favours this timing so that bleeding can be monitored and managed during working hours. Five-day withdrawal is excessive, and bridging with enoxaparin may increase bleeding without benefit. Dose reduction and conversion to warfarin are not recommended strategies for routine dental extraction.
Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd Edition, sections 3.1 and 5.1, 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf