Disseminated intravascular coagulopathy: Manifestations after a routine dental extraction

doi:10.1016/j.tripleo.2004.08.017

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 99, Issue 4, April 2005, Pages 419-423

https://doi.org/10.1016/j.tripleo.2004.08.017 Get rights and content

Clinical signs and symptoms of acute disseminated intravascular coagulopathy (DIC) include bleeding from body orifices, such as the nose, mouth, or ear, bleeding from an intravenous (IV) site, areas of ecchymosis, or blood in the urine or stool. The underlying disease triggering DIC usually determines the clinical presentation. However, patients with chronic DIC (compensated DIC) may possess subclinical signs and symptoms, and the bleeding disorder may only be identified through laboratory findings. In this compensated form, the triggering factor is exposed slowly and in small amounts (seen in malignancies and vasculitis), allowing replenishing of the augmented factors by the liver, adequate reticuloendothelial clearance of fibrin degradation products, and increased production of platelets, which prevent secondary fibrinolysis and the signs of bleeding.1, 4 We report a case of an 82-year-old male who presented to the emergency room 24 hours after a routine dental extraction with bleeding from the tooth socket, severe hypotension, and presence of ecchymosis on his chest. Clinical and radiographic exam revealed multiple thoracic and abdominal aortic aneurysms, as well as infrarenal and iliac aneurysms, continuous oral hemorrhage, and a unique presentation rarely documented in the literature: a bleeding tooth socket as the initial clinical sign and presentation of DIC.

Section snippets

Case report

An 82-year-old Latin American male presented to the hospital emergency room (ER) status-post extraction of tooth #31. The patient had noted spontaneous bleeding from his gingiva 2 days prior to visiting his dentist for the extraction. His chief complaint upon reaching the emergency room was continued bleeding since the extraction. The patient's medical history was significant for hypertension and benign prostatic hypertrophy. He was taking fosinopril and terazosin, and had no known drug

Discussion

Disseminated intravascular coagulopathy has many etiologies. The Merck Manual¹⁰ describes 4 areas in which DIC may arise: infection (particularly from gram-negative organisms), obstetrics, malignancy (usually from adenocarcinoma of the pancreas or prostate), and shock. Disease processes of particular importance to dental professionals that may cause DIC include intravascular hemolysis, septicemia, and viremia.1, 6 In addition, DIC may also be seen in a compensated form in patients with

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Cited by (12)

A case of disseminated intravascular coagulation after two-jaw surgery
2018, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
The patient has remained free of adverse events and abnormalities at two years after the surgery. Disseminated intravascular coagulation is a hemorrhagic disease characterized by imbalanced blood coagulation [10], and it is broadly coagulation- or fibrinolysis-dominant based on the degree to which the coagulation and fibrinolytic systems are activated [11]. Although PLT sharply decreases in coagulation-dominant DIC, FDP and D-dimer mildly increase, FDP and D-dimer strikingly increase, and PLT slowly decreases in fibrinolysis-dominant DIC.
Disseminated intravascular coagulation (DIC) is a serious condition that causes persistent widespread coagulation activation in the presence of underlying disease. Most patients who undergo orthognathic surgery are young and have no underlying disease. Therefore, serious postoperative complications such as DIC rarely arise. We describe a patient with DIC that developed after two-jaw surgery in the absence of underlying disease. A 31-year-old man was referred to our hospital with a chief complaint of an occlusal abnormality. He had no underlying disease and his preoperative laboratory findings were unremarkable. The patient provided presurgical, written, informed consent to orthognathic surgery including Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Perioperative findings and events were also unremarkable. The surgical duration was 4 h and 31 min. Blood loss was 435 mL and he was transfused with 400 mL of hemodiluted autologous blood. The patient developed obvious facial swelling and ecchymosis from the infraorbital area to the cheek in both sides of the face on postoperative day (POD) 5. Blood findings on POD 6 were as follows: RBC, 365 × 10⁴/μL; WBC, 9,200/μL; PLT, 0.3 × 10⁴/μL; FDP, 21.25 μg/mL; Fibrinogen, 501 mg/dL; and D-dimer, 10.67 μg/mL. Treatment for early symptomatic improvement was started, since these findings met several criteria for diagnosis of DIC. Blood parameters improved (PLT, 6.5 × 10⁴/μL; FDP, 11.05 μg/mL; D-dimer, 5.24 μg/mL) one day after the intravenous administration of prednisolone (60 mg) and transfusion with 10 units of platelet concentrate. Thereafter, the clinical course was uneventful.
Intracranial hemorrhage after tooth extraction in a patient with chronic disseminated intravascular coagulation
2015, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Disseminated intravascular coagulation (DIC) is a condition causing severe bleeding, which requires hemostatic measures be taken after surgical treatment. However, there is no clear method to assess coagulation and bleeding after surgical treatment. Here, we describe a rare case of intracranial hemorrhage after tooth extraction in a patient with chronic DIC associated with aortic dissection. A 76-year-old Japanese male reported spontaneous pain in the upper front teeth region. Tooth extraction was performed based on a diagnosis of severe periodontitis. Four hours after the extraction, re-bleeding from the tooth socket was reported. Moreover, 10 and 20 h after extraction, bleeding occurred from the tooth socket again. In both situations, the bleeding was successfully controlled by pressure hemostasis. Three and 5 days after the extraction, the patient reported to the emergency outpatient care with post-extraction hemorrhage. Twelve days after the extraction, the patient complained of spontaneous severe headache. Computed tomography (CT) of the head was taken and hemorrhage was observed in his left frontal lobe. Thirty-eight days after tooth extraction, brain hemorrhage was spontaneously evoked again. It must be noted that bleeding may occur in any part of the body in patients with DIC and not only at the surgical site.
Spontaneous Intraoral Hemorrhage as Manifestation of Thoracoabdominal Aortic Aneurysm-Associated Disseminated Intravascular Coagulation: Case Report and Review
2010, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
A hemorrhagic manifestation might be the only initial clinical marker of deteriorating compensated DIC rather than of typical acute DIC. To our knowledge, the present case is the first report of spontaneous intraoral hemorrhage directly resulting in a subsequent diagnosis of DIC, because the previously reported cases were diagnosed in the wake of persistent hemorrhage after therapeutic intervention or trauma10,11,22-28,33-36 or were recognized by systemic symptoms such as hypoxia, hypotension, or pyrexia with rigor in acute DIC with or without hemorrhage.29-32 Given that the underlying AA in our patient was inoperable and remained as the cause of chronic DIC, surgical intervention to remove the sequestra, in conjunction with improvement of the DIC in advance, was valuable, because it precluded the possibility of recurrent oral bleeding.
Minor complications after mandibular third molar surgery: type, incidence, and possible prevention
2006, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
The aim of this prospective study was to ascertain the incidence of minor complications after mandibular third molar surgery and to predict the risk of skin ecchymosis or mucosa petechiae related to the usage of an absorbable gelatin sponge.
One hundred and four patients subjected to surgical extraction of horizontally impacted lower third molars were selected and investigated by means of questionnaires and clinical examinations. The independent sample t test was used for numeric variables. The chi-square test was used for logistic variables to determine the association between variables, and thereafter stepwise logistical regression was used.
The older group (≥ 30 years old), with deeply impacted teeth, and long operation times (≥ 10 minutes) were shown to have significantly higher swelling than the other groups (P < .05). The patients who had deeply impacted teeth or long operation times were shown to have significantly higher VAS scores compared to short operation times (P < .05). The use of an absorbable gelatin sponge in the extraction socket significantly decreased postoperative swelling, mucosal petechiae, and skin ecchymosis (P < .05).
The clinical variables related to postoperative bleeding disorder, pain, and trismus were identified. The insertion of an absorbable gelatin sponge into the extraction socket was found to be a very useful method to prevent postoperative bleeding problems.
Perioperative intervention by oral medicine team in cardiovascular surgery patients
2019, General Thoracic and Cardiovascular Surgery
Disseminated Intravascular Coagulation after Surgery for Facial Injury
2016, Case Reports in Dentistry

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Oral and Maxillofacial SurgeryDisseminated intravascular coagulopathy: Manifestations after a routine dental extraction

Section snippets

Case report

Discussion

J Vasc Surg

J Oral Maxillofac Surg

Disseminated intravascular coagulation: pathophysiological mechanisms and manifestations

Sem Thromb Hemo

Aortic aneurysm-induced disseminated intravascular coagulation

Annl Vasc Surg

Diagnosis and treatment of disseminated intravascular coagulation

Indian Ped

Disseminated intravascular coagulation

J Oral Surg

Disseminated intravascular coagulation (DIC)

Clin Lab Sci

A case of disseminated intravascular coagulation thought to be caused by tooth extraction in the hypercoagulable condition due to abdominal aortic aneurysm

Nipp Naika Gakkai Zasshi

Oral and Maxillofacial Surgery
Disseminated intravascular coagulopathy: Manifestations after a routine dental extraction