Tooth extractions in hemophiliacs

Ramström, Göran; Blombäck, Margareta

doi:10.1016/s0300-9785(75)80052-4

Cited by 34 publications

(21 citation statements)

References 17 publications

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“…In the presence of tranexamic acid, neither plasminogen nor the activated proteolytic enzyme plasmin is able to bind to the lysine residues in fibrin, and thus clot degradation is inhibited (Dunn and Gao, 1999). Moreover, tranexamic acid alone has been used for many years to control bleeding and reduce overall blood loss in various types of surgical procedures, including cardiovascular and oral surgery (Ramstrom and Blomback, 1975;Vermeulen et al, 1984;Dunn and Goa, 1999), with only minimal side effects (Ramstrom and Blomback, 1975). However, several studies have reported that tAMCHA solution (Pelligrini et al, 1982) or tAMCHA incorporated in fibrin clots (Schlag et al, 2000 induces generalized epilepsy when applied topically to both hemispheres of the cerebral cortex at a low concentration of 1-3 mM.…”

mentioning

confidence: 99%

Effect of tranexamic acid incorporated in fibrin sealant clots on the cell behavior of neuronal and nonneuronal cells

Cox

Cole

Mankarious

et al. 2003

J of Neuroscience Research

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Fibrin sealants are commonly used for hemostasis following surgery on various types of tissues. Aprotinin, an effective fibrinolysis inhibitor, is one of the components in some fibrin sealant products currently available. Tranexamic acid (tAMCHA) is another fibrinolysis inhibitor and is used as an alternative to aprotinin. Recent studies on fibrin sealant products containing tAMCHA indicate that it may be responsible for various adverse reactions when used in neurological applications. To determine a possible mechanism for such adverse reactions, we examined the effect of tAMCHA on the behavior of neuronal and nonneuronal cells using in vitro assays. The data indicate that different concentrations of tAMCHA incorporated in fibrin clots had no effect on the initial cell adhesion of either proliferative cells (glial cells and fibroblasts) or nonproliferative cells (neuronal cells) to the fibrin clots. Moreover, a high concentration of tAMCHA (300-450 mM) incorporated in the fibrin clots increased glial and fibroblast proliferation on fibrin clots. However, because tAMCHA is known to leach out of the fibrin clots, we have also examined the effect of solubilized tAMCHA in a growth medium on cells seeded on matrix-coated surfaces. A high concentration (300-450 mM) of tAMCHA detached all cell types from matrix-coated dishes. Our model suggests that tAMCHA in fibrin clots has no adverse effect on cells bound to the fibrin clots; however, tAMCHA leaching out from the fibrin clots reduces adhesion of adjacent cells bound to their natural extracellular matrix. Thus, a high concentration of tAMCHA should not be used as a fibrinolysis inhibitor in fibrin sealant products, especially in neurosurgery.

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mentioning

confidence: 99%

Effect of tranexamic acid incorporated in fibrin sealant clots on the cell behavior of neuronal and nonneuronal cells

Cox

Cole

Mankarious

et al. 2003

J of Neuroscience Research

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“…For example, despite high doses and routine postoperative use of factor VIII or factor IX by Biggs et al [I] and Walsh et a1 [45], the frequency of postoperative bleeding was greater than when lower doses were used in conjunction with EACA. Ramstrom and Blomback [44] demonstrated this clearly: utilization of only factor VIII or IX, sufficient to elevate levels to 30-50%, followed by maintenance levels of 15-30% for 10 days, was associated with a 59% frequency of bleeding. In contrast, when tranexamic acid was administered and levels of only 10% were maintained for 1-2 days, only 10% of their patients experienced hemorrhage.…”

Section: Discussionmentioning

confidence: 93%

“…They found a statistically significant reduction in total replacement required as well as decreased bleeding episodes and blood loss in the tranexamic acid treated group. Ramstrom and Blomback [44] also reported that tranexamic acid resulted in reduced factor replacement and days of hospitalization; some patients served as their own controls.…”

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confidence: 99%

Evidence that less replacement therapy is required for dental extractions in hemophiliacs

1984

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The requirements for factor VIII (AHF) or factor IX (PTC) of hemophilic patients undergoing dental extractions were evaluated to determine the minimum effective regimen. Sixteen patients underwent 19 operative procedures. The mean total dose of factor VIII or IX was 45.8 U/kg for 11 procedures with preoperative replacement therapy and 34.5 U/kg for the 8 without. Four patients received no replacement therapy at all. Our results compared favorably to published studies employing factor replacement alone or in combination with antifibrinolytic agents such as epsilon-amino-caproic acid (EACA), with respect to blood products utilized and duration of hospitalization. However, our patients received less factor replacement than usually suggested. General anesthesia with intubation, a common recommendation, was not required in any patients. Dental extractions can be carried out in hemophiliacs using less replacement therapy than currently recommended. In some circumstances, no replacement therapy may be necessary. The reported efficacy of antifibrinolytic agents in reducing the requirement for replacement therapy is difficult to assess because of the relatively large amount of prophylactic factor replacement used in conjunction with these agents.

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“…Two of these five studies included only patients with mild and moderate form of haemophilia (total 26 patients), and perioperative DDAVP was the only haematological treatment . Systemic antifibrinolytics were used perioperatively for 5‐10 days in eight of those studies . In a total number of 394 patients who were treated with pre‐ and postoperative FRP or DDAVP and who underwent oral surgical procedures, mostly dental extractions (more than 1368 tooth extraction), in more than 486 treatment sessions, the overall reported bleeding rate is 104/486 (21.4%) in a range 3.9%‐45%.…”

Section: Resultsmentioning

confidence: 99%

“…The objective of several studies was to estimate the benefits of antifibrinolytic use in patients with haemophilia who require oral surgery. Authors who compared treatment regimen including systemic antifibrinolytic use vs. no antifibrinolytic use concluded that antifibrinolytics significantly reduce postoperative bleeding …”

Section: Resultsmentioning

confidence: 99%

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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Tooth extractions in hemophiliacs

Cited by 34 publications

References 17 publications

Effect of tranexamic acid incorporated in fibrin sealant clots on the cell behavior of neuronal and nonneuronal cells

Effect of tranexamic acid incorporated in fibrin sealant clots on the cell behavior of neuronal and nonneuronal cells

Evidence that less replacement therapy is required for dental extractions in hemophiliacs

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

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