ADC Practice Question — Warfarin management for dental procedures

Should the rivaroxaban be interrupted for this surgical extraction?

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. Tony Gallagher, a 66-year-old man, presents for surgical extraction of an impacted lower right wisdom tooth. He had a coronary stent placed 8 months ago and takes rivaroxaban 20 mg daily plus aspirin 100 mg daily. His cardiologist advised both medications must continue. He has no allergies and takes no other medications. Should the rivaroxaban be interrupted for this surgical extraction?

A. Switch rivaroxaban to warfarin bridging for the perioperative period
B. Stop both rivaroxaban and aspirin for 5 days to minimise bleeding, then restart after the socket has healed
C. Yes — stop rivaroxaban 48 hours before all dental extractions
D. Never interrupt DOACs for any dental procedure as the thrombotic risk always outweighs bleeding risk
E. For lower-risk invasive procedures, interruption is not required; for higher-risk procedures like this surgical extraction, consult the patient's medical practitioner about safety and timing

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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, for lower-risk invasive dental procedures, interruption of DOAC therapy is not required. For higher-risk procedures (like surgical extraction), consult the medical practitioner to assess safety and timing of any interruption. TG notes evidence on benefits of stopping DOACs before dental procedures is of low certainty. TG emphasises not stopping antithrombotics without medical advice.

Source: Ch 23: DOACs — no interruption for lower-risk; consult medical team for higher-risk procedures

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 Warfarin management for dental procedures questions structured in the ADC written exam?

ADC Warfarin 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 Warfarin 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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