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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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sence of unknown clotting factor. Lancet 1947;249:446-8.

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12. Yang TL, Cui J, Taylor JM, Yang A, Gumber SB, Gisburg D.

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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

a-kit@nagasaki-u.ac.jp

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Volume 112, Number 1 Kitamura et al. e3

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