[Dental extraction in patients with bleeding disorders. Proposal of a protocol based on the type of anesthesia used].
BACKGROUND
The authors propose a protocol to avoid bleeding complications in patients with bleeding disorders.


METHODS
When a general anesthesia or trunk nerve infiltration is indicated, clotting factor concentrates are to be used in patients with severe bleeding disorders. Desmopressin is to be used in patients with mild bleeding disorders but who are good responders and in patients with thrombopathy. An antifibrinolytic treatment and a fibrin glue are also used. Ninety-six patients underwent 107 extractions with this protocol.


RESULTS
Only two patients had bleeding complications requiring an additional treatment.


CONCLUSIONS
In case of bleeding disorders, the treatment depends on disease severity and type of anesthesia. A general treatment (clotting factor concentrates or desmopressin) is indicated with general anesthesia and with local anesthesia in severe bleeding disorders, but not absolutely necessary with local anesthesia in mild bleeding disorders. However, desmopressin can used in all good responders.
Clinique de Stomatologie et Chirurgie Maxillo-faciale, Centre Hospitalier Régional et Universitaire de Nantes, 44093 Nantes Cedex 01. benoit.piot@chu-nantes.fr
B
B
Piot
M
M
Sigaud-Fiks
P
P
Huet
E
E
Fressinaud
M
M
Trossaërt
J
J
Mercier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D025861:Blood Coagulation Disorders, Inherited / Q000188:drug therapy*; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003663:Decision Trees; D017742:Dental Care for Chronically Ill / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014081:Tooth Extraction; D014148:Tranexamic Acid / Q000627:therapeutic use
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin