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Oral Surgery · single question

A patient taking warfarin requires dental extraction. INR is 2.5. What is the most appropriate management?

  1. Discontinue warfarin 1 day prior to extraction
  2. Wait until INR is below 1.5 before extraction
  3. Discontinue warfarin 5–7 days prior and bridge with heparin
  4. Proceed with planned extraction without warfarin modification
Show answer and explanation

Correct answer: D. Proceed with planned extraction without warfarin modification

  • A. Discontinuing warfarin 1 day prior does not adequately reduce INR and unnecessarily increases thromboembolic risk.
  • B. Waiting until INR is below 1.5 means the patient is underanticoagulated and at high thrombotic risk.
  • C. Bridging therapy is reserved for high thromboembolic risk patients requiring major surgery, not routine dental extractions.
  • D. Correct. For patients on stable warfarin with an INR of 2.0–3.5, routine dental extractions can proceed WITHOUT discontinuing warfarin. Local hemostatic measures (sutures, gelatin sponge, tranexamic acid) are used. Stopping warfarin creates greater risk of thromboembolism than the minor bleeding risk from extraction.

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