Postsurgical hemorrhage resulting from a drug-induced circulating anticoagulant: report of case.
A case of circulating anticoagulant resulting in persistent postoperative bleeding has been reported. All clotting factors were normal when the patient's plasma was tested in a high dilution. Unlike previous reports of this type of coagulation inhibitor, the hemorrhagic diathesis was clinically severe in comparison with the mildly abnormal in vitro tests. Many unknowns remain: the chemical nature of this anticoagulant; the time needed to return to normal coagulation levels; the frequency and severity of drug-induced anticoagulation; and the dose and duration of usage of medications resulting in circulating anticoagulants. In retrospect, the only clinical evidence suggestive of a coagulation problem in this case was a marginally elevated partial thromboplastin time. In our opinion, a preoperative coagulation screening, consisting of prothrombin time, partial thromboplastin time, platelet count, and template bleeding time, may help to prevent serious postoperative hemostatic complications.
D000974:Antibodies, Antinuclear / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis / Q000276:immunology; D005164:Factor IX / Q000037:antagonists & inhibitors; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D006472:Oral Hemorrhage / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D014081:Tooth Extraction
D000974:Antibodies, Antinuclear; D001779:Blood Coagulation Factors; D005164:Factor IX