Peri-operative management of multiple tooth extractions in a patient with congenital hypofibrinogenemia receiving anticoagulant therapy

Congenital fibrinogen disorder is rare and is responsible for the difficulty in achieving hemostasis following surgery. A 75-year-old man was referred to our hospital for the management of gingival hemorrhage. He had a medical history of congenital hypofibrinogenemia, right internal carotid stenosis, hypertension, brain infarction, and Alzheimer's disease. A diagnosis of gingival hemorrhage due to periodontitis of the maxillary left second molar and severe periodontitis necessitating extraction in the maxillary second molars bilaterally, mandibular left second molar, and mandibular right first and third molars was made. A pre-operative hematological examination revealed a fibrinogen level of 53.7 mg/dl. Fibrinogen (3 g) was administered and reached a concentration of 92.8 mg/dl before the surgery. Several episodes of post-operative hemorrhages in the sockets were managed with local hemostatic treatment and splint adjustment. Fibrinogen levels were maintained at 72.5-92.8 mg/dl, until hemostasis was achieved. This case report illustrates the appropriate management of patients with congenital hypofibrinogenemia requiring extraction of multiple teeth.