title: Oral surgery-associated postoperative bleeding in haemophilia patients - a tertiary centre's two decade experience.
abstract: Our goal in this research was to evaluate potential and targeted therapy, correlated with haemophilia severity and dental procedural risk, to reduce postoperative bleeding risk. Patients with haemophilia who were treated at the Oral and Maxillofacial Surgery Clinic at Sheba Medical Center between 1996 and 2012 comprised the study cohort. Data collected included disease history and severity, perioperative factor concentrate therapy, local haemostatic agent application, systemic tranexamic acid use and outcome. Bleeding was defined as excessive bleeding during or within 20 days following procedure. Dental procedures (n = 1968) of 125 patients were studied. Patients' bleeding risk score was evaluated according to the severity of haemophilia with or without the presence of an inhibitor, presence of comorbid coagulopathy and the type of dental procedure. Thirty-four patients undergoing a total of 880 high-risk and 1088 low-risk procedures suffered 40 postoperative bleeding events that necessitated further dental and/or haematological intervention. Among risk factors for delayed bleeding, the use of fibrin glue was significantly (P = 0.027) associated with the risk of postprocedural bleed probably as it was applied to high-risk patients and procedures. Earlier treatment period (P = 0.055), postprocedure hospitalization (P = 0.039) and dental "high-risk" procedures (P < 0.0001) also increased bleeding risk. Patients with haemophilia may be safely treated if meticulous haemostasis is applied, along with fibrin glue and systemic therapy as required. Factor transfusions are not mandatory and should be applied considering the procedure-related risk and the patient's calculated haematological risk for bleeding.
authors.affiliation: Unit of Oral and Maxillofacial Surgery, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Givol
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Ramat Gan, Israel.|Sackler Medical School, Tel Aviv University, Ramat Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Hirschhorn
authors.affiliation: Sackler Medical School, Tel Aviv University, Ramat Gan, Israel.|National Hemophilia Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Lubetsky
authors.affiliation: Sackler Medical School, Tel Aviv University, Ramat Gan, Israel.|National Hemophilia Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Bashari
authors.affiliation: Sackler Medical School, Tel Aviv University, Ramat Gan, Israel.|National Hemophilia Center, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Kenet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: dental; factor; haemophilia; haemostasis; surgical