Congenital antithrombin III (AT M) deficiency is inherited as an autosomal dominant trait. Patients with this condition have an increased risk of venous thrombosis, developing either spontaneously or after trauma, surgery, or pregnancy.
We performed dental extraction in a 31-year-old man with congenital AT III deficiency who was given only warfarin preoperatively and postoperatively. His AT M activity was 56.2%. During warfarin therapy, the results of the thrombo test and the International Normalized Ratio were 9.7% and 1.88, respectively.
After consultation with physicians, we decided to extract teeth while the patient continued to receive his current regimen of warfarin therapy, because his laboratory data were stable and it was important to avoid venous thrombosis. Dental extraction was performed in 3 blocks to minimize the risk of surgery. Primary hemostasis was completely achieved. Although the patient did not receive AT III concentrate, there was no postoperative hemorrhage or episodes of thrombosis.
Our findings suggest that oral surgeons should carefully consult with physicians when planning dental extraction in patients with AT M deficiency who are receiving anticoagulant therapy.
