title: Autologous plasma rich in growth factors in the prevention of severe bleeding after teeth extractions in patients with bleeding disorders: a controlled comparison with fibrin glue.
abstract: BACKGROUND
  Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and haematological interventions. As a local haemostatic, fibrin glue has recognised efficacy but, as a plasma-derived product, it carries the risk of viral infections. We, therefore, compared fibrin glue with an autologous haemostatic, plasma rich in growth factors (PRGF), in a controlled trial.
  
  
  METHODS
  One hundred and twenty patients with different blood disorders were randomised into two cohorts to undergo dental extraction procedures without hospitalisation. Prior to the extractions, patients underwent systemic haematological treatment. Complications were defined as secondary bleeding after the 7-day follow-up period or protracting after the repair procedure.
  
  
  RESULTS
  There were 106 extractions (7 retained 3(rd) molars) in the group managed with fibrin glue: secondary bleeding affected 3/60 patients (5%) on the third day after extraction and necessitated additional surgery and systemic treatment (in one case the procedure had to be repeated on the 7(th) day). In the PRGF arm there were 98 extractions (23 retained 3(rd) molars): secondary bleeding affected two patients (3.3%) on the first day after extraction and was arrested with surgery without systemic treatment. Four out of the five secondary bleeds occurred in patients with haemophilia A. Concomitant diabetes or liver disease significantly increased the bleeding risk.
  
  
  CONCLUSIONS
  The bleeding rates in the study and control arm prove that PRGF works as well as fibrin glue as a local haemostatic. Further assets are that PRGF has autologous origin, does not require additional systemic treatment in post-extraction repair surgery, is associated with an earlier onset of neo-angiogenesis and, overall, can reduce patients' distress and costs to the health system.
authors.affiliation: Oral Surgery Unit, Dental School, Joint Hospital-University Institution "Città della Salute e della Scienza", Turin, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Cocero
authors.affiliation: Oral Surgery Unit, Dental School, Joint Hospital-University Institution "Città della Salute e della Scienza", Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pucci
authors.affiliation: Centre for Inherited Bleeding and Thrombotic Disorders, Transfusion Unit, Joint Hospital-University Institution "Città della Salute e della Scienza", Turin, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.affiliation: Centre for Inherited Bleeding and Thrombotic Disorders, Transfusion Unit, Joint Hospital-University Institution "Città della Salute e della Scienza", Turin, Italy.
authors.forename: Berardino
authors.initials: B
authors.lastname: Pollio
authors.affiliation: SIOM Oral Surgery and Implantology Centre, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mozzati
authors.affiliation: Oral Surgery Unit, Dental School, Joint Hospital-University Institution "Città della Salute e della Scienza", Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bergamasco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D013997:Time Factors; D014081:Tooth Extraction