title: Management of dental extractions in patients with bleeding disorders.
abstract: OBJECTIVE
  This study evaluated the effectiveness of a protocol to prevent bleeding after dental extraction in patients with hemophilia, von Willebrand's disease (VWD), or platelet disorders.
  
  
  METHODS
  Replacement therapy was used in cases involving general anesthesia, and nerve trunk infiltration was used in patients with severe bleeding disorders (severe-to-moderate hemophilia or type 2-3 VWD). Desmopressin was used in good responders with mild hemophilia A, type 1 VWD, and platelet disorders. Local hemostatic measures and antifibrinolytic treatment were used systematically.
  
  
  RESULTS
  Ninety-three patients underwent 103 dental extractions; 2 of these patients had secondary bleeding requiring surgical hemostasis.
  
  
  CONCLUSIONS
  The indication for replacement therapy depended on the type of anesthesia that was used. Coagulation factor concentrates or desmopressin were necessary to avoid upper airway hematoma with general anesthesia or nerve trunk infiltration. With local anesthesia, substitutive treatment was indicated in patients with severe-to-moderate hemophilia and type 2-3 VWD. Inexpensive desmopressin was effective in those who responded well. Local hemostatic measures and antifibrinolytic treatment were performed systematically.
authors.affiliation: Clinique de Stomatologie et Chirurgie Maxillo-faciale, Centre Hospitalier Régional et Universitaire de Nantes, France. benoit.piot@chu-nantes.fr
authors.forename: Benoit
authors.initials: B
authors.lastname: Piot
authors.forename: Marianne
authors.initials: M
authors.lastname: Sigaud-Fiks
authors.forename: Pascal
authors.initials: P
authors.lastname: Huet
authors.forename: Edith
authors.initials: E
authors.lastname: Fressinaud
authors.forename: Marc
authors.initials: M
authors.lastname: Trossaërt
authors.forename: Jacques
authors.initials: J
authors.lastname: Mercier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001791:Blood Platelet Disorders / Q000628:therapy; D001803:Blood Transfusion; D002648:Child; D002985:Clinical Protocols; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D005260:Female; D006467:Hemophilia A / Q000628:therapy; D006474:Hemorrhagic Disorders / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects; D014842:von Willebrand Diseases / Q000628:therapy
chemical_list: D000933:Antifibrinolytic Agents; D006490:Hemostatics; D003894:Deamino Arginine Vasopressin