A patient taking apixaban calls several hours after an extraction reporting continued oozing despite biting on gauze. What should you do?

Correct answer: B. Ask her to come in for evaluation and local haemostatic measures

• A. Prolonged oozing is not normal and dismissing it over the telephone abandons the patient.
• B. CORRECT. Persistent bleeding after the initial period needs direct assessment. Nearly all bleeding in anticoagulated dental patients is controllable with LOCAL measures: re-packing under proper pressure, oxidized regenerated cellulose or a collagen plug in the socket, suturing, and a tranexamic acid mouthrinse.
• C. This is backwards — waiting for the next dose adds more anticoagulant, and in any case the timing of dosing is not the issue.
• D. Simply telling her to press harder without assessment leaves an uncontrolled bleed unmanaged overnight.

Note: Never instruct a patient to alter or stop an anticoagulant without the prescribing physician's involvement — thromboembolic risk from interruption generally exceeds bleeding risk from continuation. For routine dental surgery, DOACs such as apixaban and rivaroxaban are usually continued; if the procedure is extensive, some physicians will advise skipping the morning dose or timing the appointment for the drug trough. Tranexamic acid 4.8% rinse, 10 mL for 2 minutes four times daily for 2 days, is highly effective adjunctive management.