Which laboratory value in an otherwise healthy patient would MOST clearly require medical consultation before ELECTIVE dental treatment?

Correct answer: C. INR of 4.5

• A. An ANC of 1200 is mildly reduced but above the commonly used 1000/mm3 threshold for concern. Routine care can proceed; prophylaxis is generally considered below 500–1000.
• B. A SHORT bleeding time is not a bleeding risk — the concern would be a prolonged one.
• C. CORRECT. An INR of 4.5 is ABOVE the therapeutic range for essentially every indication (target 2.0–3.0, or 2.5–3.5 for mechanical mitral valves). Dental procedures with bleeding risk are generally safe up to an INR of about 3.5 with local hemostatic measures; above 4.0 the risk of prolonged and difficult-to-control hemorrhage rises sharply, and the patient needs physician review and dose adjustment before elective surgery.
• D. An HbA1c of 7.5% represents reasonably controlled diabetes and does not preclude elective dental treatment.

Note: Get a current INR — ideally within 24 hours of the procedure, or up to 72 hours in a stably anticoagulated patient.