• Yoshinari Morimoto, Hitoshi Niwa, and Takeshi Nakatani.
• Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan. ysn-mori@dent.osaka-u.ac.jp
• Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Dec 1;110(6):e7-10.

AbstractIn 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.Copyright © 2010 Mosby, Inc. All rights reserved.

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