Extensive bleeding following extractions in a patient undergoing chronic hemodialysis

A prolonged epistaxis following routine dental extractions was observed in a 50-year-old woman with a history of chronic hemodialysis. Despite the clinical impression of a significant coagulopathy, extensive hematologic testing failed to reveal any abnormalities. Recent evidence suggests that a prostaglandin (prostacyclin) with platelet antiaggregatory properties may be responsible for episodes of prolonged bleeding reported in patients undergoing hemodialysis.