Accidental oral bleeding in a dementia patient taking anticoagulants: A case report

Abstract

Accidental bleeding in the oral cavity is often encountered in older individuals. If the patient is taking anticoagulants for diseases such as atrial fibrillation or venous thromboembolism, anticoagulant effects may be the basis of the bleeding. 1 For several decades, warfarin was the only oral agent available for long-term anticoagulation, but its long half-life and narrow therapeutic range necessitate regular coagulation monitoring using the international normalized ratio. 2,3 Recently, direct oral anticoagulants such as rivaroxaban, dabigatran and apixaban have gained increasing use worldwide, because routine coagulation monitoring is not required. 2,4 Oral anticoagulants are used by many older individuals.Older people are at higher risk of developing dementia, and the use of oral anticoagulants among older people with dementia has been promoted. 5 Direct oral anticoagulants are also being used in patients with dementia. 2,6 Among cases of accidental oral bleeding attributed to the dental field in older individuals taking anticoagulants, bleeding due to periodontal disease is usually considered. 7,8 Poor control of anticoagulants and high blood pressure may be thought of as triggers. 9However, oral bleeding can involve a wide variety of contributing factors, and the cause is often difficult to investigate, especially in geriatric facilities (other than hospitals) as limited medical environments. In addition, the oral cavity itself may be difficult to examine in patients with dementia. 10 Here, we report a case of repeated oral bleeding in which the site of bleeding could not be identified, in a patient with dementia who was a resident of an aged care facility and was taking the anticoagulant rivaroxaban.As a result of an in-facility multidisciplinary consultation including staff such as dental hygienists, nutritionists and caregivers, the cause of oral bleeding was considered most likely due to selfscratching with a spoon during meals. The aim of this study was