ADC Practice Question — DOACs management for dental procedures

What is the most critical factor that affects management planning for this patient?

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Mr. David Chen, a 58-year-old man, presents urgently on a Saturday morning with severe pain from a lower right wisdom tooth. He had a coronary artery stent placed 4 months ago and takes warfarin plus aspirin 100 mg daily. His cardiologist has advised he must remain on both medications. He has an INR of 3.0 from Friday's blood test. Clinical examination reveals a partially erupted tooth 48 with pericoronitis and localised swelling but no trismus or systemic signs of infection. What is the most critical factor that affects management planning for this patient?

A. The aspirin should be stopped for 7 days before any dental procedure to reduce bleeding risk
B. Saturday appointments are unsuitable for procedures on anticoagulated patients and he should return on Monday
C. The pericoronitis requires immediate surgical extraction of the wisdom tooth regardless of his medications
D. The INR of 3.0 is too high for any surgical intervention
E. He is on combination anticoagulant and antiplatelet therapy, placing him in the highest bleeding risk category

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: E

According to TG, patients on a combination of anticoagulant and antiplatelet therapy are at the highest bleeding risk. The medical team must be consulted and specialist dental referral should be considered. This combination therapy is the most critical factor affecting management planning, as it requires coordination with the cardiologist.

Source: Ch 23: Combination anticoagulant + antiplatelet = highest bleeding risk

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

How are DOACs management for dental procedures questions structured in the ADC written exam?

ADC DOACs management for dental procedures questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Should I memorise guidelines word-for-word for DOACs management for dental procedures?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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What is the most critical factor that affects management planning for this patient?

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