Optimising local therapy during oral surgery in patients with von Willebrand disease: effective results from a retrospective analysis of 63 cases

Abstract

Bleeding after dental extractions is very frequent in patients with von Willebrand disease (vWD) and in the past often necessitated transfusions with factor VIII/von Willebrand factor concentrates (vWFc). To evaluate the benefits of a standard local therapy on bleeding complications during oral surgery, 63 consecutive patients with vWD were analysed retrospectively. All types of vWD were included: type 1 (n=31), type 2 (n=22) and type 3 (n=10). All the patients had dental extractions or periodontal surgery at the same hospital by the same oral surgeons. All cases had been given tranexamic acid (TA) before and for 7 days after surgery. As additional local therapy fibrin glue (FG) was used during surgery in several patients. Additional systemic therapies were: desmopressin (DDAVP, 0.3 microg kg-1) and fVIII/vWF concentrates (vWFc, 40 U kg-1) given as a single dose before surgery. The 29 subjects (46%) treated locally did not bleed. Among the remaining cases, 24 (38%) were given DDAVP as additional systemic therapy and 6 (9.5%) received vWFc. There was bleeding after surgery in only two cases who had been given local FG (type 2 B) or systemic vWFc (type 3), but bleeding was stopped with an additional local application of FG. Our data suggest that a standard local therapy with TA and FG with DDAVP can prevent bleeding complications during oral surgery in the majority of patients (84%) with vWD and reduce the need for concentrates, with all their possible complications and high costs.

The Successful Use of Desmopressin With Tranexamic Acid in Children With Mild Type 1 Von Willebrand Disease Who Undergo Circumcision

“…Almost all parents of patients with VWD are willing to have their children circumcised. Short-term DDAVP prophylaxis was successfully applied ranging from 91% to 100% to prevent excessive bleeding following surgery or invasive procedures in patients with type 1 VWD [9,10]. In our study, clinical responses were excellent with no bleeding episode.…”

Retrospective review of the management of elective surgery with desmopressin and clotting factor concentrates in patients with von Willebrand disease

“…In contrast, in the Nordic survey neither the FVIII:C levels nor the BT were routinely monitored in connection with surgery [13]. There are other groups who similarly found that at least during oral surgery the monitoring of FVIII/ VWF levels was probably not necessary [14].…”

von Willebrand Disease in Dental Clinic: An Exclusive Case Report with Review of Literature

“…Careful attention to hemostasis of an extraction socket and to suturing of sockets is also important in oral surgery in persons with vWD (grade C, level IV). 22 For fillings done under infiltration with local anesthetic, treatment with DDAVP or concentrates is not needed. Treatment should be given if an inferior dental block is to be used (grade C, level IV).…”