2023 Volume 44 Issue 3 Pages 255-261
Risk assessment and response to bleeding have been reported for extraction of teeth in patients undergoing antithrombotic therapy. However, there are no reports on assessing the risk of reinfarction. We report the case of a patient undergoing antithrombotic therapy who suffered cerebral embolisms twice after tooth extraction.
A 60-year-old male patient with cardiogenic cerebral embolism was transferred to our hospital for rehabilitation. On the 46th day after onset of illness, the patient underwent extraction of a mandibular right second bicuspid with severe periodontitis under edoxaban therapy. Six days after the extraction, the patient had aphasia and MRI showed a relapse, so the patient was sent to an acute care hospital, and then later was readmitted to our hospital. On the 112th day after the initial onset of illness, the patient underwent extraction of a maxillary right central incisor with apical periodontitis under apixaban therapy. Three days after the extraction, the patient suffered a relapse with worsening dysarthria and so was again sent to an acute care hospital.
Considering the risk of bleeding and reinfarction during tooth extraction, the patient underwent extraction under antithrombotic therapy. However, reinfarction occurred six days and three days after tooth extraction. Inflammation induces hypercoagulability in the bloodstream, which leads to thrombus formation, so it is important to take anti-inflammatory measures before and after tooth extraction. Considering the possibility of recurrence of cardiogenic cerebral embolism a few days after tooth extraction, as in this case, it is necessary to check the patient’s physical condition for several days after invasive treatment. When performing invasive treatment, it is necessary to explain the procedure thoroughly, obtain consent, and collect information on the patient’s life circumstances, such as whether or not the patient lives alone.
