{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:35:51Z","timestamp":1793036151246,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Special Care in Dentistry"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Secondary immune thrombocytopenia (SITP) has been rarely reported following mRNA COVID\u201019 vaccination. Oral manifestations such as gingival bleeding remain underrecognized in dental practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 58\u2010year\u2010old woman developed extensive ecchymoses, blood\u2010tinged sputum, and spontaneous gingival bleeding approximately 2 weeks after receiving the second dose of the mRNA\u20101273 COVID\u201019 vaccine. Laboratory testing revealed severe isolated thrombocytopenia, while coagulation parameters, D\u2010dimer, and fibrinogen levels were within normal limits. After exclusion of other identifiable causes, she was diagnosed with suspected SITP temporally associated with COVID\u201019 vaccination. Initial treatment with dexamethasone resulted in an insufficient platelet response; therefore, intravenous immunoglobulin was administered, leading to platelet recovery. During the subsequent periodontal scaling, however, profuse gingival bleeding occurred despite a platelet count exceeding 50 \u00d7 10\n                      <jats:sup>3<\/jats:sup>\n                      \/\u00b5L. Conventional local hemostatic measures, including pressure application and retraction paste, were unsuccessful. Fibrin glue was then applied, resulting in immediate hemostasis without recurrent bleeding during follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of recognizing vaccine\u2010associated SITP in dentistry and demonstrates fibrin glue as an effective adjunctive hemostatic measure when conventional approaches are insufficient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scd.70261","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:25:20Z","timestamp":1789989920000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Refractory Gingival Bleeding During Periodontal Therapy in Vaccine\u2010Associated Immune Thrombocytopenia: A Case Report"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4885-5879","authenticated-orcid":false,"given":"Hee\u2010Jin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Dentistry Kosin University Gospel Hospital Kosin University College of Medicine  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1928-3384","authenticated-orcid":false,"given":"Kyung\u2010San","family":"Min","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry School of Dentistry, Jeonbuk National University  Jeonju Republic of Korea"},{"name":"Research Institute of Clinical Medicine Jeonbuk National University  Jeonju Republic of Korea"},{"name":"Biomedical Research Institute of Jeonbuk National University Hospital  Jeonju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26132"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100253"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104840"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2105385"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1810479"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2017.04.012"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000812"},{"issue":"2","key":"e_1_2_12_9_1","first-page":"159","article-title":"Immune Thrombocytopenic Purpura Detected With Oral Hemorrhage: A Case Report","volume":"19","author":"Sugiura T.","year":"2018","journal-title":"Journal of Dentistry 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