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Cirrhosis Coagulopathy — RACP Adult Medicine MCQ

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HardHaematologyCirrhosis CoagulopathyRACP Adult Medicine

A 50-year-old man with alcoholic cirrhosis has a platelet count of 42 × 10⁹/L and requires an elective dental extraction. INR is 1.8. What is the most appropriate pre-procedure management?

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Correct answer: C — No specific intervention needed as dental extraction is low-risk

Standard coagulation tests (INR, platelet count) poorly reflect bleeding risk in cirrhosis due to rebalanced haemostasis (reduced pro- and anticoagulant factors). Simple dental extractions are considered low-risk procedures. Prophylactic correction of INR or platelets is NOT routinely recommended for low-risk procedures. Tranexamic acid may be used as an adjunct. Guidelines recommend against the routine use of FFP and platelets based solely on laboratory values in cirrhosis.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2018 – Decompensated Cirrhosis Coagulopathy