Oral bleeding in hemophilia: Treatment with epsilon aminocaproic acid and replacement therapy

Abstract

Sixteen hemophiliac children with oral bleeding were treated with the antifibrinolytic agent epsilon aminocaproic acid (EACA) and replacement therapy. Thirteen had factor VIII (AHF) deficiency, and 3 had factor IX (PTC) deficiency. Ten patients had nondental oral bleeding, usually in the form of lacerated frenulums; 6 patients had dental extractions. All patients were given an initial infusion of the deficient coagulation factor to ensure adequate initial clot formation. EACA was given every 6 hours, beginning 24 hours before dental surgery, or in an initial loading dose in those patients with nondental oral bleeding, and continued for 5 to 10 days. In all patients, bleeding stopped within one hour; no patient required continued replacement therapy. In one patient EACA alone was ineffective in controlling the bleeding. The results suggest that the combined use of EACA and initial replacement therapy is effective in controlling oral bleeding in hemophiliac patients; the length of hospital stay is reduced, and in some instances bleeding episodes can be managed on an outpatient basis.