title: 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.
authors.affiliation: Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre and Department of Internal Medicine, IRCCS Maggiore Hospital and University of Milan, Milan, Italy. augusto.federici@unimi.it
authors.forename: A B
authors.initials: AB
authors.lastname: Federici
authors.forename: R
authors.initials: R
authors.lastname: Sacco
authors.forename: F
authors.initials: F
authors.lastname: Stabile
authors.forename: M
authors.initials: M
authors.lastname: Carpenedo
authors.forename: E
authors.initials: E
authors.lastname: Zingaro
authors.forename: P M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D019468:Disease Management; D005169:Factor VIII / Q000008:administration & dosage; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006487:Hemostasis / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology / Q000517:prevention & control; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010510:Periodontal Diseases / Q000150:complications / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects; D014148:Tranexamic Acid / Q000008:administration & dosage; D014842:von Willebrand Diseases / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D014841:von Willebrand Factor / Q000008:administration & dosage
chemical_list: D015718:Fibrin Tissue Adhesive; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin