warfarin and Pericoronitis

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.

Topics: Adult; Aspirin; Blood Coagulation Factors; Blood Loss, Surgical; Cellulose, Oxidized; Contraindications; Electrocoagulation; Female; Fibrinolytic Agents; Gingival Hemorrhage; Heart Failure; Heart-Assist Devices; Hematoma; Hemostatics; Heparin; Humans; International Normalized Ratio; Male; Molar, Third; Periapical Periodontitis; Pericoronitis; Plasma; Postoperative Hemorrhage; Prothrombin Time; Thrombosis; Tooth Extraction; Tooth, Impacted; Warfarin