A patient on apixaban had an extraction and calls several hours later reporting continued oozing despite biting on gauze. What is the BEST response?

Correct answer: A. Ask her to come to the office so you can evaluate and achieve local hemostasis

• A. CORRECT. Post-extraction bleeding in an anticoagulated patient is managed with LOCAL measures — but it must be EVALUATED. Bring the patient in, remove the clot, identify the source, and apply local hemostatics: oxidized cellulose or gelatin sponge in the socket, sutures, firm pressure, and tranexamic acid mouthwash (4.8%, held 2 minutes, four times daily for 2–5 days). This is highly effective and avoids any change to anticoagulation.
• B. Dismissing continued bleeding without assessment risks a large hematoma, airway compromise in the floor of the mouth, or significant blood loss.
• C. NEVER instruct a patient to alter anticoagulation on their own — the thromboembolic risk (stroke, PE) far exceeds the bleeding risk from a dental socket, and only the prescribing physician should make that decision.
• D. Waiting for the next dose does nothing to control active bleeding and delays care.

Note: Local hemostasis works. Tranexamic acid rinse is the single most useful adjunct and is under-used.