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Pharmacology · single question

A patient is on warfarin for venous thromboembolism with an INR of 2.0 and needs extraction of posterior molars. What is the most appropriate management?

  1. Discontinue warfarin 1 day prior to extraction
  2. Proceed with planned extractions without discontinuing warfarin
  3. Coordinate with physician to reduce INR to 1.5 before extraction
  4. Use idarucizumab (Praxbind) as a reversal agent
Show answer and explanation

Correct answer: B. Proceed with planned extractions without discontinuing warfarin

  • A. Stopping warfarin 1 day before does not meaningfully reduce INR and creates unnecessary thrombotic risk.
  • B. Correct. An INR of 2.0 is within the therapeutic range for patients with VTE. Current evidence and guidelines support proceeding with dental extractions WITHOUT stopping warfarin for patients with INR ≤3.5. Local hemostatic measures (sutures, pressure, gelatin sponge, tranexamic acid) are used. Stopping warfarin increases thromboembolism risk far more than the bleeding risk from a dental extraction.
  • C. Targeting INR <1.5 means the patient is significantly under-anticoagulated and at increased thromboembolic risk.
  • D. Idarucizumab is the reversal agent for dabigatran (a direct thrombin inhibitor), not warfarin. Vitamin K and fresh frozen plasma reverse warfarin.

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