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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)
 

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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.[1]

References

  1. On the use of prothrombin complex concentrate in patients with coagulopathy requiring tooth extraction. Morimoto, Y., Niwa, H., Nakatani, T. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod (2010) [Pubmed]
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