Management of dental extractions in patients with bleeding disorders.
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.
Piot
Benoit
B
Clinique de Stomatologie et Chirurgie Maxillo-faciale, Centre Hospitalier Régional et Universitaire de Nantes, France. benoit.piot@chu-nantes.fr
Sigaud-Fiks
Marianne
M
Huet
Pascal
P
Fressinaud
Edith
E
Trossaërt
Marc
M
Mercier
Jacques
J
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
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D003894:Deamino Arginine Vasopressin