Management options for dental extraction in hemophiliacs: a study of 55 extractions (2000-2002).
OBJECTIVE
Dental extraction in hemophiliacs is associated with a high risk of bleeding. It requires a multidisciplinary approach and stringent protocol. The current trend is to simplify these protocols. In this study we review the efficacy of a protocol using systemic treatment--factors/dihydro-D-arginine vasopressin (DDAVP)--and simplified local hemostatic measures to control bleeding, to limit patient discomfort, and to minimize hospital length of stay.


METHODS
This retrospective study of 55 dental extractions was performed during 19 interventions in 16 patients with hemophilia A or B to assess the efficacy of a protocol combining general management via the injection of factor concentrates or DDAVP and local hemostasis using biological glue and gelatin packing. Compressive, hemostatic splints, which have been in use by some for many years, are replaced by intermittent tranexamic acid compression during the first 3 days after surgery.


RESULTS
We recorded 6 instances of postsurgical bleeding, 4 of which occurred after the compression period. In 2 cases repetition of the local hemostasic measures was required along with the injection of an antihemophilic factor concentrate. In the other 4 cases, the patients' condition reverted to normal following injection of the factor concentrate and the reapplication of the compression.


CONCLUSIONS
The adopted protocol produced a reliable outcome, limiting the duration of the hospital stay to 24 hours in most cases, and improving postsurgical comfort thanks to a combination of systemic treatment and local hemostasic measures including intermittent tranexamic acid compression.
Frachon
Xavier
X
Department of Pathology and Oral Surgery, Rennes University Medical Center, Rennes, France.
Pommereuil
Michèle
M
Berthier
Anne-Marie
AM
Lejeune
Sophie
S
Hourdin-Eude
Solenn
S
Quéro
Jérôme
J
Mézière
Xavier
X
De Mello
Gilbert
G
Garnier
Julien
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002985:Clinical Protocols; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D017742:Dental Care for Chronically Ill / Q000379:methods*; D005164:Factor IX / Q000008:administration & dosage; D005169:Factor VIII / Q000008:administration & dosage; D006467:Hemophilia A / Q000628:therapy; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D014081:Tooth Extraction / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage
D006490:Hemostatics; D014014:Tissue Adhesives; D014148:Tranexamic Acid; D005169:Factor VIII; D005164:Factor IX; D003894:Deamino Arginine Vasopressin