HEMORRHAGE AFTER TREATMENT OF MRONJ ASSOCIATED WITH ANTIPHOSPHOLIPID ANTIBODY SYNDROME

Antiphospholipid antibody syndrome (APS) is an autoimmune disease characterized by thromboembolic events or pregnancy-related complications caused by antiphospholipid antibodies. The following case reports a patient diagnosed with APS, osteoporosis, and atherosclerosis. The medication for treatment and control of the diseases were warfarin, low-molecular-weight heparin, aspirin, and alendronate. Clinical and radiographic examination revealed an intraoral fistula, with spontaneous purulent drainage in a 2-month previous tooth extraction area and signs of bone sequestrum both compatible with medication-related osteonecrosis of the jaw (MRONJ). Surgical debridement for the removal of the bone sequestrum was performed with an International Normalized Ratio (INR) of 2.13 and an activated partial thromboplastin time (aPTT) of 37.9 seconds with local hemostatic agents. Two episodes of postsurgical hemorrhage and formation of a "liver clot" were observed (INR = 2.85 and aPTT = 51.5 s). After discussion with the medical team, aspirin and low-molecular-weight heparin were suspended. Reopening of the area, removal of the clot, and local hemostatic control were performed with no hemorrhage or any further complication.