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consistent, and patients without significant manifesta-
tions have been reported.6 The relative contribution of
plasma versus platelet FV to FVa (factor Y)binding
interactions in the prothrombinase complex are not
clearly defined.8 Even though FV deficiency is a rare
bleeding disorder, it follows the pathophysiologic com-
plexity of defects in the coagulation pathways.9 Oral
surgeons should keep in mind that prothrombotic
Fig. 1. A,Pre- and, B, Post-extraction panoramic x-rays of the patient. C-F, Sockets 1 day after the extractions. Bleeding from
the wounds had already stopped (24 h).
Fig. 2. The patients value of clinical blood coagulation analysis before and after extractions (24 h).A,Changes of factor V beforeand after extraction. The level was increased 11% of normal during infusion of fresh frozen plasma (FFP; 450 mL), activated
partial thromboplastin time (APTT) (B), prothrombin time (PT) (C), and PTinternational normalized ratio (INR) (D), were
estimated as 20% of normal level before extraction. The levels of APTT and PT corrected to 50% of normal after infusion of the
FFP but still far from the normal level.
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agents used preoperatively may increase the risk for
acute myocardial infarction in the presence of the factor
V Leiden mutation before a tooth extraction.10 Further-
more, single-chain FV acts as a cofactor contributing to
the acceleration of inactivation of factor VIIIa by acti-
vated protein Cprotein S complex (anticoagulant).11
There are few reports dealing with the extraction atsurgery levels involving deficiency of FV (parahemo-
hilia).7 Extraction of 4 wisdom teeth were carried out at
1 time under the level of FV within 10% of normal
levels during operation. The complicated bleeding dia-
thesis that survived longer appeared to reflect platelet,
rather than plasma, FV activity. These results suggest
that platelet factor V is an essential component in
maintaining stable and prolonged hemostasis after
trauma.12 Because it appears that there is enough FV
available on the unperturbed platelet surface to provide
an optimal contribution to prothrombinase complex,
assuming its maximal activation, these observationswould suggest some inherent advantage of platelet-
released FVaover that in the plasmatic environment of
the platelet.13 Most likely, the recruitment and concen-
tration of platelets to a site of vascular injury provides
an excess of local platelet FVa receptor sites that re-
quire the release of the localize, stored platelet FV.14,15
CONCLUSIONA patient whose coagulation FV decreased below 1%
of normal level underwent extraction of the 4 wisdom
teeth under transfusion of FFP (450 mL).
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Reprint requests:
Dr. Akira Kitamura
Division of Oral and Maxillofacial Surgical Reconstruction and
Functional Restoration
Graduate School of Biomedical Sciences
Sakamoto, Nagasaki
852-8588 Japan
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Volume 112, Number 1 Kitamura et al. e3
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