A patient treated with a vitamin K antagonist (VKA)
since the implantation of two mechanical heart valves developed acute anemia
after the extraction of a tooth. This case report and data in the literature
indicate a need for specific measures before, during, and after oral surgery in
patients taking anticoagulant therapy: 1) the bleeding risk should be evaluated
before the procedure. The INR should be measured routinely, 2) the procedure
should be scheduled early in the week to allow an evaluation at the
fibrinolysis peak, i.e., 48 to 72
hours after surgery, which is the time of greatest risk of delayed bleeding, 3)
the surgical procedure should be appropriate for the elevated bleeding risk, 4)
postoperative monitoring is of the most importance, as bleeding is usually
delayed in patients on VKA therapy, 5) when poor treatment adherence is expected,
day-hospital admission is useful to ensure that the postoperative protocol is
implemented properly and to detect early bleeding. The treatment of post-extraction
acute anemia includes local hemostasis protocol with the revision of the socket
followed by red-blood-cell pack transfusion. A daily fluindione dosage control,
and a normal hemoglobin level will allow the patient to leave the hospital.
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