On the use of prothrombin complex concentrate in patients with coagulopathy requiring tooth extraction.
In patients on high-level anticoagulant therapy (prothrombin time-international normalized ratio [PT-INR] ≥ 4.5), surgical procedures can be carried out with bridging therapy using heparin. However, surgical treatment options are severely limited in patients on high-level anticoagulant therapy and who have heparin-induced thrombocytopenia (HIT), as heparin use is contraindicated. We performed tooth extraction using prothrombin complex concentrate (PCC) in 2 HIT patients on high-level anticoagulation therapy (PT-INR ≥ 4.5). Five hundred units of PCC were administered intravenously, and after 15 minutes, it was confirmed that PT-INR was less than 2.0. Tooth extraction was then performed and sufficient local hemostasis was achieved. At 3 hours after tooth extraction, PT-INR was 2.0 or higher and later increased to 4.0 or higher, but postoperative bleeding was mostly absent. When performing tooth extraction in HIT patients on high-level anticoagulant therapy, favorable hemostatic management was achieved through sufficient local hemostasis and transient warfarin reversal using PCC.
Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan. ysn-mori@dent.osaka-u.ac.jp
Yoshinari
Y
Morimoto
Hitoshi
H
Niwa
Takeshi
T
Nakatani
D000328:Adult; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002483:Cellulose, Oxidized / Q000627:therapeutic use; D000075202:Contraindications; D004564:Electrocoagulation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005884:Gingival Hemorrhage / Q000209:etiology; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices; D006406:Hematoma / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use*; D006493:Heparin; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008964:Molar, Third / Q000601:surgery; D010485:Periapical Periodontitis / Q000601:surgery; D010497:Pericoronitis / Q000601:surgery; D010949:Plasma; D019106:Postoperative Hemorrhage / Q000209:etiology; D011517:Prothrombin Time; D013927:Thrombosis / Q000188:drug therapy*; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000601:surgery; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D001779:Blood Coagulation Factors; D002483:Cellulose, Oxidized; D005343:Fibrinolytic Agents; D006490:Hemostatics; C025667:prothrombin complex concentrates; D014859:Warfarin; C013695:Surgicel; D006493:Heparin; D001241:Aspirin