Sir, in response to S. Antoniou and their caution regarding providing simple extractions in patients who may experience bleeding complications,1 we write to express our concern. This experience does sound like it was difficult for all but appears to have been expertly managed by the author. There is increasing confidence in managing patients on direct oral anticoagulants (DOACs) in primary care and comprehensive guidelines (SDCEP2) regarding this; we would be very concerned if this were to change. The primary haemostasis was well achieved, and the delayed presentation suggests a potential infective cause for the bleeding. In a periodontally involved tooth, the surrounding tissues will be more friable and inflamed so a prolonged ooze is more likely. Working in primary and secondary care, we can assure you that the initial treatment in secondary care would have been entirely the same, but would involve a delay to treatment, likely unnecessary antibiotic use, further pain and risk of spreading infection for the patient. A delayed haemorrhage may still have presented in practice and would have been managed exactly as the author did. Teaching on the MSc in Oral Surgery at UCLAN, we aim to empower our students with a solid evidence and experience base to safely carry out a range of procedures in a primary care setting. With increasing pressures on all levels of healthcare, we should not underestimate our knowledge and skills as clinicians and shy away from relieving pain and resolving infection when we are able, for fear of potential complications.