Oral Surgery · patient case question
Which value tells you whether his anticoagulation is within a range compatible with a simple extraction?
Patient case: Medically complex man requesting extraction of a painful tooth
Patient: Male, 56 years old
Chief complaint: “This tooth kept me awake all night. I want it out today.”
Background: Type 2 diabetes. Prostate cancer treated 2 years ago. Currently taking warfarin, bisphosphonates and antihypertensive medication.
Vital signs / labs: INR 2.4
Current findings: Non-restorable tooth with symptomatic irreversible pulpitis. Patient is insistent that it be removed at this visit.
Show answer and explanation
Correct answer: C. The INR
- A. Platelet count assesses primary haemostasis and is not what warfarin affects.
- B. Bleeding time is an obsolete, poorly reproducible test no longer used for this purpose.
- C. CORRECT. Warfarin inhibits vitamin K–dependent factors (II, VII, IX, X) and is monitored by the INR. His INR of 2.4 sits within the usual therapeutic window, and simple extractions are generally safe with local haemostatic measures at an INR up to roughly 3.5.
- D. PTT monitors the intrinsic pathway and is used for unfractionated HEPARIN, not warfarin.