Warfarin Local Haemostasis — MFDS Part 1 MCQ

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ModerateOral Surgery PrinciplesWarfarin Local HaemostasisMFDS Part 1

Following uncomplicated extraction of a single tooth in a patient taking warfarin, persistent socket oozing remains despite firm gauze pressure. The INR was checked within the preceding 24 hours and is 3.5, with no additional bleeding-risk factors. Which management is most appropriate?

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Reveal the answer and explanation

Correct answer: D — Pack the socket with oxidised cellulose and place sutures

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

A is correct. An INR of 3.5 is below the SDCEP threshold of 4, so warfarin should not be interrupted and treatment proceeds with local measures alone. Persistent socket bleeding is managed by packing with a haemostatic material such as oxidised cellulose and suturing to retain the pack and stabilise the clot; the patient should not be discharged until haemostasis is achieved, so B is unsafe. Intravenous tranexamic acid (C) and fresh frozen plasma (D) are disproportionate systemic interventions, and plasma reversal is reserved for major or life-threatening haemorrhage, not socket ooze. Withholding warfarin for five days (E) exposes the patient to avoidable thromboembolic risk and does nothing for the immediate bleeding. An INR of 4 or above would instead require delay or urgent liaison with the anticoagulation service.

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