6 months have passed since the stent placement, the…
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. After 6 months have passed since the stent placement, the wisdom tooth still requires extraction. The patient remains on warfarin and aspirin. What is the most appropriate approach to managing his antithrombotic therapy for the extraction?
- A. Stop both warfarin and aspirin 5 days before the extraction
- B. Switch warfarin to a DOAC such as rivaroxaban before the extraction, as DOACs have lower bleeding risk
- C. Stop the aspirin but continue warfarin, as warfarin alone provides sufficient thrombotic protection
- D. Continue both medications, consult the patient's cardiologist to evaluate bleeding risk, and consider specialist dental referral
- E. Continue both medications and proceed with extraction in the dental practice with standard local haemostatic measures
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Show the answer and cited explanation
According to TG, patients on combination anticoagulant and antiplatelet therapy are at the highest bleeding risk. The patient's medical practitioner must be consulted to evaluate the impact on bleeding risk. Specialist dental referral or management by experienced clinicians should be considered. TG states antithrombotic drugs must not be stopped without consulting the prescribing medical practitioner.
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