Outpatient minor oral surgery in patients with hemophilia: A case series of 23 patients

Ramos, Emilio A.; Diamante, Maximiliano; Caruso, Diego; Muiño, Juan M.; Baques, Alejandra; Antonelli, L.; Gutiérrez, J. Beltrán; Minigutti, M.; Guerrero, Gabriela

doi:10.4317/jced.55506

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…Prothrombin Time is also prolonged in patients who are receiving Vitamin K antagonists and anticoagulants, such as warfarin 11,12 . Hemophilia A is usually treated mainly with infusion of recombinant Factor VIII; this treatment is currently widely preferred due to its greater safety 13,14 . However, in some cases, this treatment be used only as needed 15 .…”

Section: Discussionmentioning

confidence: 99%

A Case of Multiple Mandibular Molar Extractions for a Hemophilia a Patient

Jaber¹,

Alshame²,

Natarajan³

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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Hemophilia A is a genetic coagulation disorder associated with a deficiency of clotting factor VIII.It can be inherited or acquired and have different levels of severity. The present case report describes a Libyan male patient with Factor VIII deficiency who underwent multiple remaining roots extraction.The patient was a 26-year-old Libyan male with history of hemophilia A of mild type. The patient underwent blood tests and imaging to assess the severity of hemophilia and the condition of the surgical area. The blood examination revealed normal Bilirubin level (0.6), low levels of, RBC (4.55), HGB (10.9), PT (17.7) and slight changes in platelet count and Factor VIII level.The treatment plan for the day of surgery was accordingly, the patient was administered Factor VIII 24 hours before the day of surgery. The patient underwent the multiple roots extraction of lower left first and second molar under local anesthesia using 2% Lidocaine with 1:80, 000 Adrenaline. The Injection technique was regional nerve block (inferior alveolar, Lingual, and long buccal nerve block).After extraction, direct pressure on the area using a damp gauze swab, maintained for at least 30 min, a hemostat and multiple thread suture were applied. One hour after surgical removal of the roots again the patient administered Factor VIII.There was no subsequent bleeding or complications at follow-up in the first three days. In the fourth day there was moderate bleeding at the extraction sockets continued for a day. At fifth day the patient was admitted at the Sebha Medical Centre. The bleeding stopped after 24 hours.Treatment plan in the Medical Centre was administration of factor FVIII, tranexamic acid 500 mg three times a day and vitamin K once a day. All injections were given intravenously. Then the patient discharged from the Centre in the sixth day after bleeding controlled. The wound had healed completely without abnormalities.

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Section: Discussionmentioning

confidence: 99%

A Case of Multiple Mandibular Molar Extractions for a Hemophilia a Patient

Jaber¹,

Alshame²,

Natarajan³

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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“…Ramos and colleagues published the results of using TXA in conjunction with low doses of factor replacement in a series of 23 patients who underwent 30 minor oral surgical procedures. Apart from one mild case of bleeding (in a patient who did not show good compliance with postoperative instructions) all patients did very well 32 …”

Section: Role Of Anti‐fibrinolytics To Reduce Use Of Clotting Factor ...mentioning

confidence: 95%

“…Apart from one mild case of bleeding (in a patient who did not show good compliance with postoperative instructions) all patients did very well. 32 TXA has been widely used in orthopaedic surgeries in PWH. Huang et al reported 18 total hip and 24 knee arthroplasties performed in PWH with, or without, TXA, and concluded that with TXA there were significant benefits: less perioperative blood loss, less overall blood loss, lower transfusion rate, a lower rate of postoperative knee swelling, less postoperative joint pain, lower levels of inflammatory biomarkers and better joint function.…”

Section: Role Of Anti-fibrinolytics To Reduce Use Of Clotting Factor ...mentioning

confidence: 99%

Low dose prophylaxis and antifibrinolytics: Options to consider with proven benefits for persons with haemophilia

Carção

Gouider

2022

Haemophilia

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Introduction: Prophylaxis has become standard of care for persons with severe phenotype haemophilia (PWsH). However, 'standard prophylaxis' with either factor or non-factor therapies (emicizumab) is prohibitively expensive for much of the world.We sought to evaluate whether haemophilia care can be provided at a lower cost yet achieve good results using Lower dose/Lower frequency prophylaxis (LDP) and with increasing use of antifibrinolytics (Tranexamic acid and Epsilon amino caproic acid). Methods:We identified 12 studies that collectively included 335 PWsH using LDP.Additionally, we undertook a literature search regarding the benefits of antifibrinolytics in haemophilia care.Results: Identified studies show that LDP is far superior to no prophylaxis (On demand[OD] therapy) resulting in significant patient benefits. Patients on LDP showed (in comparison to patients OD) on average: 72% less total bleeds; 75% less joint bleeds; 91% less days lost from school; 77% less hospital admission days; and improved quality of life measures. These benefits come at similar or only slightly higher (< 2-fold greater) costs than OD therapy. Antifibrinolytics are effective adjunctive agents in managing bleeds (oral, nasal, intracranial, possibly other) and providing haemostasis for surgeries (particularly oral surgeries). Antifibrinolytics can substitute for more expensive factor concentrates or can reduce the use of such concentrates. There is evidence to show that antifibrinolytics may be used in conjunction with factor concentrates/emicizumab for more effective/less costly prophylaxis. Conclusions:The use of LDP along with appropriate and increased use of antifibrinolytics offers less resourced countries good options for managing patients with haemophilia.

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“…19 Existing studies, mostly retrospective studies with small sample size, show considerable variability in haemostatic coverages. [19][20][21] There are also little data available on the optimal care of patients with rare bleeding disorders, paediatric patients or those with inhibitors.…”

Section: Introductionmentioning

confidence: 99%

“…A survey done in the United Kingdom showed that the lack of knowledge of clinicians about dental procedures often leads to overtreating 19 . Existing studies, mostly retrospective studies with small sample size, show considerable variability in haemostatic coverages 19–21 . There are also little data available on the optimal care of patients with rare bleeding disorders, paediatric patients or those with inhibitors 7,22,23 .…”

Section: Introductionmentioning

confidence: 99%

Post‐procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders

Champagne

Bourassa

Desjardins³

et al. 2022

Haemophilia

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Introduction Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. Aim To compare the outcomes and use of haemostatic treatment pre‐ and post‐implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. Methods We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013‐2020), comparing patients’ outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment‐related adverse effects. Results Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment‐related adverse effects were reported. Conclusion The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.

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Outpatient minor oral surgery in patients with hemophilia: A case series of 23 patients

Cited by 3 publications

References 14 publications

A Case of Multiple Mandibular Molar Extractions for a Hemophilia a Patient

A Case of Multiple Mandibular Molar Extractions for a Hemophilia a Patient

Low dose prophylaxis and antifibrinolytics: Options to consider with proven benefits for persons with haemophilia

Post‐procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders

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