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Oral Surgery · single question

A patient on warfarin presents with an INR of 2.5 for a simple tooth extraction. What is the most appropriate action?

  1. Proceed with extraction using local hemostatic measures
  2. Refer to physician for INR adjustment
  3. Postpone extraction until INR is below 1.5
  4. Stop warfarin for 5 days before extraction
Show answer and explanation

Correct answer: A. Proceed with extraction using local hemostatic measures

  • A. Correct. Current evidence supports safe simple extraction in patients on warfarin with INR ≤3.5. An INR of 2.5 is within safe range. Proceed with extraction and use local hemostatic measures (pressure, sutures, tranexamic acid if needed). Do not alter warfarin.
  • B. Physician referral is not needed if INR is within therapeutic range (≤3.5) for simple extraction.
  • C. Postponing for INR <1.5 is not indicated and places the patient at unnecessary thromboembolic risk.
  • D. Stopping warfarin before extraction increases thromboembolic risk without significant benefit for simple extractions at therapeutic INR levels.

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