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Supratherapeutic INR — MCCQE Part 1 MCQ

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HardBleeding DisorderSupratherapeutic INRMCCQE Part 1

A 29-year-old woman with type 1 von Willebrand disease has baseline VWF activity 0.42 IU/mL and only mild prior mucosal bleeding. She needs one uncomplicated dental extraction. Her bleeding-disorder team confirms no contraindication to antifibrinolytic therapy. Which peri-procedural plan is most appropriate?

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Correct answer: B — Tranexamic acid alone with local dental hemostatic measures

For a minor mucosal procedure in mild type 1 VWD, baseline VWF activity above 0.30 IU/mL and a mild bleeding phenotype, tranexamic acid alone with local measures is an appropriate strategy. Antifibrinolytic therapy is particularly useful in the oral cavity, where fibrinolysis is prominent. Desmopressin or VWF concentrate is reserved for patients or procedures needing a higher factor response, guided by subtype, prior response and bleeding-disorder expertise. PCC, prophylactic platelets and warfarin are inappropriate and potentially harmful. Major surgery, severe phenotype, type 2 or type 3 disease requires a different individualized plan.

Reference: ASH/ISTH/NHF/WFH, VWD Treatment Pocket Guide: https://www.hematology.org/-/media/hematology/files/clinicians/guidelines/ash-vwd-treatment-pocket-guide-0902-web-watermark.pdf