No increased bleeding risk for oral surgery in patients with severe congenital bleeding disorders due to intense perioperative management

Goldmann, G.; Berens, Christina; Marquardt, Natascha; Reich, Rudolf H.; Oldenburg, Johannes; Wenghoefer, Matthias

doi:10.1007/s10006-014-0476-z

Cited by 4 publications

(24 citation statements)

References 18 publications

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“…Regimen involving multiple preoperative and postoperative infusions of FRP is mostly historical. However, alongside older studies, there were several relatively newer studies that continue to suggest this protocol . In eleven reviewed studies, preoperative and postoperative FRP was used in their dental protocol (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Individuals without haemophilia were the control group in two studies. Both of those studies find no significant difference in postoperative bleeding between PWH who received perioperative FRP and the unaffected controls . The influence of HIV infection, as comorbidity, on postoperative complications was the goal of one study.…”

Section: Resultsmentioning

confidence: 99%

“…In five studies, different local haemostatic modalities were compared . The most commonly used local haemostatic agents in the reviewed studies were cellulose and fibrin glue . In some studies, fibrin sealants were used in combination with other local haemostatic agents such as collagen or gelatin alveolar packing material.…”

Section: Resultsmentioning

confidence: 99%

“…Antifibrinolytic agents, such as tranexamic acid (TA) or epsilon‐aminocaproic acid (EACA), are plasminogen inhibitors that block proteolysis of fibrin clots, and they can be used both systemically and locally. Some authors suggest perioperative systemic use of antifibrinolytics with local topical use of these drugs either applied directly in the wound, or in the form of mouthwash solution . Saliva and gingival sulcus fluid contain plasminogen and plasminogen activators and do not contain plasminogen inhibitors, and mouthwash is often used as a 5% solution for 5‐7 days after the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…However, alongside older studies, there were several relatively newer studies that continue to suggest this protocol. [11][12][13][14] In eleven reviewed studies, preoperative and postoperative FRP was used in their dental protocol (Table 1). The preoperative regimes varied from raising factor level from > 10% 15,16 to 50%-100%.…”

Section: Haematological Treatment For Dental Extractions In Patientmentioning

confidence: 99%

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Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Bajkin

Dougall

2020

Haemophilia

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Due to the global prevalence of oral disease, tooth extraction is the most common surgical procedure required in general population thus likely to be similarly common in patients with haemophilia, especially those in older age and those living in countries with restricted resources. There are little or no consensus about optimal level and duration of factor replacement (FRP) therapy required to prevent bleeding complication following surgery and low levels of evidence to inform protocols and guidelines. The goal of this article was to review the literature regarding haematological treatment protocols and to assess their effectiveness in prevention of bleeding complications during and after tooth extractions in people with haemophilia. A total number of 29 articles were identified. Only two of the studies were randomized controlled trials, and meta‐analysis was not possible. Significant heterogeneity regarding haematological regimes, dental surgical procedures, disease severity and sample size of published studies which are unable to reliably inform the provision of safe dental surgery was noted. Based on the haematological regimens, all studies were classified into one of three groups: pre‐ and postoperative FRP or DDAVP, single preoperative FRP or DDAVP, and no FRP treatment. The overall reported bleeding rate in case of both pre‐ and postoperative FRP and single dose FRP preoperative is similar, 11.9% and 11.4%, respectively, indicating that minimizing the use of clotting factor concentrate is possible if proper local haemostatic measures are provided. Strictly designed prospective studies with higher number of patients are necessary to get firm conclusions about optimal FRP treatment required to prevent bleeding complications during and after oral surgery in patients with haemophilia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Haematological Treatment For Dental Extractions In Patientmentioning

confidence: 99%

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Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Bajkin

Dougall

2020

Haemophilia

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Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience

Landart

Barbay

Chamouni

et al. 2022

Journal of Stomatology, Oral and Maxillofacial Surgery

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Oral surgery in people with inherited bleeding disorder: A retrospective study

Fribourg,

Castet,

Fénelon

et al. 2024

Haemophilia

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IntroductionThe objectives were to describe the peri‐operative management of people with inherited bleeding disorders in oral surgery and to investigate the association between type of surgery and risk of developing bleeding complications.Materials and MethodsThis retrospective observational study included patients with haemophilia A or B, von Willebrand disease, Glanzmann thrombasthenia or isolated coagulation factor deficiency such as afibrinogenemia who underwent osseous (third molar extraction, ortho‐surgical traction, dental implant placement) or nonosseous oral surgery between 2014 and 2021 at Bordeaux University Hospital (France). Patients and oral surgery characteristics were retrieved from medical records. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.ResultsOf the 83 patients included, general anaesthesia was performed in 16%. Twelve had a bleeding complication (14.5%) including six after osseous surgery. The most serious complication was the appearance of anti‐FVIII inhibitor in a patient with moderate haemophilia A. All bleeding complications were managed by a local treatment and factor injections where indicated. No association was observed between type of surgery (osseous vs. nonosseous) and risk of bleeding complications after controlling for sex, age, disease type and severity, multiple extractions, type of anaesthesia and use of fibrin glue (OR: 3.21, 95% CI: .69–14.88).ConclusionIn this study, we have observed that bleeding complications after oral surgery in people with inherited bleeding disorders were moderately frequent and easily managed. However, in this study, we observed a serious complication highlighting the necessity of a thorough benefit‐risk balance evaluation during the preoperative planning of the surgical and medical protocol.

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No increased bleeding risk for oral surgery in patients with severe congenital bleeding disorders due to intense perioperative management

Cited by 4 publications

References 18 publications

Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience

Oral surgery in people with inherited bleeding disorder: A retrospective study

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