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

The patient with multiple myeloma exhibited specific coagulation abnormalities following dental extractions.

• Laboratory tests revealed prolonged prothrombin time and thrombin time
• Reduced factor VII levels were identified as part of the coagulation disturbance
• Bleeding originated from both maxillary and mandibular dental sockets
• Bleeding persisted for several days following the extractions

Initial standard hemostatic management with intravenous vitamin K and fresh frozen plasma failed to achieve hemostasis.

• Intravenous vitamin K was administered as part of the initial management strategy
• Fresh frozen plasma was also used in the initial treatment approach
• Neither intervention was sufficient to control the hemorrhage
• The failure of standard treatments reflects the complex hemostatic imbalance in multiple myeloma

Low-dose tranexamic acid achieved effective hemorrhage control and improved alveolar socket healing despite the patient's high thrombosis risk.

• Tranexamic acid was initiated despite the recognized risk of thrombosis in this patient
• The treatment resulted in effective hemorrhage control
• Improved healing of the alveolar sockets was observed following tranexamic acid administration
• The decision to use tranexamic acid required weighing antifibrinolytic benefit against thrombotic risk

Multiple myeloma creates a complex hemostatic imbalance between pro- and anticoagulant factors that poses significant diagnostic and therapeutic challenges.

• The case illustrates 'the complex hemostatic imbalance between pro- and anticoagulant factors in a patient with multiple myeloma'
• The condition simultaneously presents high bleeding risk and high thrombosis risk
• Standard coagulation correction therapies may be insufficient in this context
• The case underscores 'the diagnostic and therapeutic challenges associated with managing bleeding in patients with a high risk of thrombosis'