DOACs No INR Monitoring — MFDS Part 1 MCQ

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EasyHuman DiseaseDOACs No INR MonitoringMFDS Part 1

Which anticoagulant is normally taken without routine monitoring of its anticoagulant effect using the international normalised ratio (INR)?

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Reveal the answer and explanation

Correct answer: B — Rivaroxaban

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

Rivaroxaban is a direct oral anticoagulant (DOAC). DOACs produce a more predictable anticoagulant effect than vitamin K antagonists, so routine INR monitoring is neither required nor appropriate; INR does not reliably quantify their anticoagulant activity. Patients still require clinical review and appropriate monitoring of factors such as renal function, adherence and bleeding. Warfarin, acenocoumarol and phenindione are vitamin K antagonists whose anticoagulant effect is assessed using the INR, allowing doses to be adjusted to the therapeutic range. Therefore, options B, C and D require INR monitoring, and option E is incorrect. Specialised drug-specific coagulation assays may occasionally be used for DOACs in exceptional circumstances, but this is not routine INR monitoring.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition, Sections 5 and 6. March 2022. https://www.sdcep.org.uk/media/ypnl2cpz/sdcep-management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs-2nd-edition.pdf