Severe bleeding diathesis after dental extractions: a complex case of coagulation disturbances in a patient with multiple myeloma

This case report describes a male patient diagnosed with multiple myeloma who experienced significant bleeding from both the maxillary and mandibular dental sockets following dental extraction, lasting several days. Laboratory tests revealed prolonged prothrombin time and thrombin time, accompanied by reduced factor VII levels. Initial management with intravenous vitamin K and fresh frozen plasma failed to achieve hemostasis. Despite the risk of thrombosis, low-dose tranexamic acid was initiated, resulting in effective hemorrhage control and improved healing of the alveolar sockets. This case illustrates the complex hemostatic imbalance between pro- and anticoagulant factors in a patient with multiple myeloma. It also underscores the diagnostic and therapeutic challenges associated with managing bleeding in patients with a high risk of thrombosis.

Keywords: Multiple myeloma; Hemorrhage; Tooth extraction; Blood coagulation

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