Warfarin and simple dental extraction — ORE Part 1 MCQ
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Correct answer: A — Proceed with extraction using local haemostatic measures
Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E
The correct answer is C. Current SDCEP (Scottish Dental Clinical Effectiveness Programme) guidance, which is NICE-accredited and endorsed by UK dental colleges, recommends that simple extractions can be safely performed in primary dental care when the INR is below 4.0, without interrupting warfarin. The patient's INR of 2.6 is stable and within the therapeutic range for atrial fibrillation. Local haemostatic measures (sutures and packing material such as oxidized cellulose or collagen sponge) are the appropriate management strategy, supported by evidence showing no significant difference in bleeding outcomes between continued and interrupted warfarin. Discontinuing warfarin (A) unnecessarily increases thrombotic risk; vitamin K (B) is only indicated for INR >4.0 or signs of excessive anticoagulation; general anaesthesia (D) is not required for straightforward extractions in anticoagulated patients; metronidazole (E) is neither indicated for a simple extraction nor relevant to warfarin management.
Reference: SDCEP Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs (2nd edition, 2024). https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/treatment-recommendations/warfarin-or-another-vitamin-k-antagonist/