For a patient with a prosthetic heart valve on warfarin needing an extraction, which management approach is advisable?

In the context of managing a patient with a prosthetic heart valve who is on warfarin and requires a dental extraction, option C is advisable because it addresses both the risk of endocarditis and the need for anticoagulation management.

Patients with prosthetic heart valves are at a higher risk for infective endocarditis, which necessitates prophylactic antibiotic coverage during dental procedures such as extractions. Gentamycin and vancomycin are effective choices for achieving broad-spectrum coverage against organisms that could potentially lead to endocarditis.

Stopping warfarin is crucial in this scenario to minimize the risk of excessive bleeding during the extraction procedure. However, this must be balanced with ensuring the patient remains appropriately anticoagulated to prevent thromboembolic events. Administering heparin allows for bridging anticoagulation, giving the patient temporary protection while their warfarin is paused.

Finally, suturing at a later time, after the extraction site has stabilized and bleeding has been controlled, is a prudent approach to manage postoperative complications effectively. This method ensures that the site has adequate healing conditions and reduces the risk of postoperative bleeding.

This choice comprehensively prioritizes both the prevention of infection and the management of anticoagulation in