Haemostatic Management of Multiple Tooth Extraction in Patients with Haemophilia

Abstract

Objective: To retrospectively investigate haemostatic management of multiple tooth extraction (≥ teeth) inpatients with haemophilia.Patients and Methods: Thirty patients underwent 35 tooth extractions. Haemostatic management was compared between minimal tooth extraction (1 or 2 teeth) and multiple tooth extraction (≥3 teeth) among patients with haemophilia A or B. Among patients with haemophilia A, the activity of plasma factor VIII was increased to about 80% from 1 hour before extraction and was maintained at 50 to 60% at 12, 24, and 48 hours after extraction in the multiple tooth extraction group. In addition, synthetic vasopressin was used in patients with mild or moderate haemophilia A, with 0.4 μg/kg of vasopressin administered 1 hour before extraction and as needed 24 hours after extraction. Among patients with haemophilia B, the activity of plasma factor IX was increased to about 60% from I hour before extraction and was maintained at 30 to 40% at 24 and 48 hours after extraction in the multiple tooth extraction group.Results: No postoperative bleeding was seen in any patients with haemophilia A, but postoperative bleeding was seen for 1 patient in the haemophilia B group.Conclusions: Dental preventive management is important for patients with haemophilia. Haemostasis was achieved for all the patients studied. In the multiple tooth extraction group, the plasma level of factor VIII concentrate was increased for patients with haemophilia A while that of plasma factor IX concentrate was increased for patients with haemophilia B, as part of systemic haemostatic measures. In patients with mild or moderate haemophilia A, vasopressin was also used.