Haemostatic management of intraoral bleeding in patients with von Willebrand disease.
OBJECTIVE
To develop plans for the haemostatic management of intraoral bleeding in patients with von Willebrand disease (VWD).


METHODS
Thirty-seven episodes of haemostatic management of intraoral bleeding in 19 VWD patients were analysed retrospectively based on the medical records.


CONCLUSIONS
When performing tooth extractions in patients with type 1 or 2A VWD [responsive to 1-deamino-8-D-arginine-vasopressin (DDAVP)], 0.35-0.4 microg kg(-1) of DDAVP should be administered intravenously at three times. In patients with type 2A VWD (unresponsive to DDAVP) or patients with type 2B or 2N VWD, 50-90 U [as ristocetin cofactor (VWF:RCof)] kg(-1) of a factor VIII concentrate containing von Willebrand factor (FVIII/VWF concentrate) should be administered twice in routine extractions, and four to six times in surgical extractions. Gingival bleeding related to primary teeth can be mostly managed by pressure haemostasis alone. However, when treating gingival bleeding caused by marginal periodontitis, it is often necessary to administer 0.4 microg kg(-1) of DDAVP or 40-70 U (as VWF:RCof) kg(-1) of a FVIII/VWF concentrate. As local haemostasis is difficult to achieve in bleeding from the tongue or labial or mandibular haematoma, it is necessary to administer 0.4 microg kg(-1) of DDAVP or 60-80 U (as VWF:RCof) kg(-1) of a FVIII/VWF concentrate. In addition, oral administration of 20 mg kg(-1) day(-1) of tranexamic acid should be combined with the regimens described above.
Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan. ysn-mori@dent.osaka-u.ac.jp
Y
Y
Morimoto
A
A
Yoshioka
M
M
Sugimoto
Y
Y
Imai
T
T
Kirita
D000293:Adolescent; D000328:Adult; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006472:Oral Hemorrhage / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011312:Pressure; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects; D014148:Tranexamic Acid / Q000627:therapeutic use; D014842:von Willebrand Diseases / Q000150:complications; D014841:von Willebrand Factor / Q000627:therapeutic use
D006490:Hemostatics; D014841:von Willebrand Factor; D014148:Tranexamic Acid; D005169:Factor VIII; D003894:Deamino Arginine Vasopressin