Teeth extraction with anticoagulation therapy in a patient with protein S deficiency

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  • 抗凝固療法のもとに抜歯術を行った先天性プロテインＳ欠乏症の１例

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Abstract

Protein S deficiency is associated with multiple thrombosis resulted from a decrease in vitamin-K dependent protein S. Surgical treatment of patients with this condition requires anticoagulant control with heparin and warfarin potassium.<BR>We report a case of protein S deficiency who received anticoagulant control with heparin and warfarin potassium during multiple teeth extraction. A 27-year-old woman was referred to our hospital because of dental caries and malocclusion. Her medical history did not include venous thromboembolism, but her mother and sister had protein S defficiency.<BR>Protein S deficiency was diagnosed because free-PS antigen was 50.0%(normal range, 65-135 %) and total-PS antigen was 22.0 %(normal range, 60-150%).<BR>Before extraction of the lower left second premolar and both lower third molars, 10, 000units/day of intravenous heparin and 2.0mg/day of warfarin potassium was administered orally when the activated clotting time (ACT) ranged from 130-150 seconds.<BR>Both upper first premolars and the third molar were also extracted affer oral administration of 2.0mg/day of warfarin potassium.<BR>Our experience suggested that anticoagulant therapy with heparin and warfarin potassium for surgical treatment of patients with protein S deficiency provides an excellent perioperative condition without inducing excessive hemorrhage or thromboembolism.

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