Local Hemostatic Measures Research Articles

The effect of Vitamin K antagonists as anticoagulants on bleeding in patients post-dental procedures

Background: Individuals undergoing continuous treatment and taking vitamin K antagonist (VKA) and other anticoagulant medications are at a higher risk of experiencing bleeding complications during and after dental surgery procedures. Objective: To determine the effect of vitamin K antagonists in post-dental procedure patients by exploring existing literature on managing patients on vitamin K antagonist therapy as anticoagulants. Methods: This research utilized a literature review based on a database search of studies published between 2019-2024. The literature search used strategies with the terms “Tooth extraction bleeding,” “Odontectomy bleeding,” “Vitamin K Antagonist,” and “Anticoagulant,” utilizing databases such as PubMed, Science Direct, and SCOPUS related to the research topic and meeting eligibility criteria. The studies were then reviewed, summarized, and conclusions were drawn using tables to reveal all data regarding study characteristics and results. Results: Patients using anticoagulants are categorized as high risk for bleeding when undergoing invasive dentistry procedures. VKA is the most commonly used anticoagulant to prevent blood clotting. The consumption of VKA does not significantly affect bleeding post-procedure. Dental procedures can be performed on patients taking anticoagulants without discontinuing the therapy. Conclusion: Based on several studies from various literature sources, it can be concluded that dental procedures in patients taking vitamin K antagonist anticoagulants can still be performed without the risk of bleeding complications with proper local hemostatic measures and perioperative management.

Management of antithrombotic therapy in patients undergoing dental procedures

A growing number of patients receiving antithrombotic therapy require dental procedures. Dental interventions in these patients can be challenging, as the risk of bleeding from the continuation of antithrombotic therapy needs to be weighed against the thromboembolic risk associated with drug interruption or de-escalation. Most minor dental procedures, including simple dental cleaning and filling, pose minimal bleeding risk, and antiplatelet or anticoagulation therapy can be continued without interruption. Local hemostatic measures, such as tranexamic mouthwash, can be used, as needed, to reduce bleeding events following these interventions. Managing antithrombotic therapy during more invasive dental interventions and oral surgeries with a higher risk of perioperative bleeding necessitates the consideration of specific factors influencing the bleeding risk and thromboembolism. In patients receiving antithrombotic therapy for primary prevention, temporary interruption is reasonable. In others, the decisions may be more complex and more nuanced. In this article, we review the current evidence for managing patients receiving oral antiplatelet or anticoagulant drugs scheduled for various dental procedures and present a practical approach for the periprocedural management of antithrombotic treatments.

Evaluation of Bleeding Time after Dental Extractions during Uninterrupted Single or Dual Antiplatelet Treatment - A Comparative Study

Abstract Introduction: This study aimed to assess the duration of bleeding after dental extractions amongst subjects with uninterrupted single antiplatelet therapy and dual antiplatelet therapy (DAPT) and to compare the bleeding time after dental extractions amongst those subjects undergoing various antiplatelet therapies. Materials and Methods: Post-extraction bleeding time was categorised as within 30 min, within 1 h and within 24 h. The bleeding time in different categories was compared and analysed using Chi-square. The antiplatelet agents assessed were aspirin, clopidogrel, ticagrelor and a combination of aspirin with clopidogrel and ticagrelor. Results: Bleeding time was significantly higher in patients under DAPT, compared to those under single antiplatelet therapy, and with an increase in the number of teeth extracted, there was an increase in bleeding time. All cases with prolonged bleeding could be managed with local haemostatic measures. Discussion: Simple extraction can be undertaken safely in patients under single antiplatelet therapy, considering that local haemostatic measures are available for use in the setup to control bleeding if necessary. Patients under DAPT are better managed if the therapy is altered, as there was a definite increase in bleeding time in patients under DAPT after extraction.

Management of Patients Receiving Anticoagulation Therapy in Dental Practice: A Systematic Review.

Anticoagulant drugs are a valuable tool for minimizing thrombotic risks in at-risk patients. The purpose of this study is to conduct a literature review highlighting the management of these drugs during daily clinical dental practice. We limited our search to English-language papers published between 1 January 1989, and 7 March 2024, in PubMed, Scopus and Web of Science that were relevant to our topic. In the search approach, the Boolean keywords "anticoagulant AND dentistry" were used. Twenty-five clinical trials were included for final review from 623 articles obtained from the databases Web of Science (83), PubMed (382), and Scopus (158), eliminating duplicates and 79 off-topic items, resulting in 419 articles after removing 315 entries and confirming eligibility. Overall, these studies support the use of local hemostatic measures to manage the risk of bleeding in patients on anticoagulant therapy undergoing dental procedures and highlight the importance of greater education and collaboration among healthcare professionals. Research and clinical investigation have improved understanding and management of dental procedures in patients undergoing anticoagulant or antiplatelet therapy. Hemostatic agents, clinical protocols, risk factors, and continuous education are essential for navigating the complexities of anticoagulant therapy, ensuring optimal outcomes and enhancing patient well-being.

Knowledge of Practicing Students and Dental Surgeons Regarding Anti- coagulation Therapy of Patients Undergoing Dental Extractions

Introduction: Dentists are still confused about whether to stop anticoagulants during extractions or to practice local hemostatic measures and closely monitor patients' international normalized ratios (INR) levels. Aims & Objectives: To determine and analyze the level of knowledge of practicing students and dental surgeons regarding anticoagulation therapy of patients undergoing dental extractions. Place and Duration of Study: A descriptive cross-sectional study was conducted among dentists and dental students in a teaching dental hospital (Islamabad Dental Hospital) for 5 months between August to December 2021. Material & Method: There were a total of 127 participants including BDS students, house officers, postgraduate trainees, and faculty members of all dental clinical departments who responded to the printed questionnaire. A convenience sampling technique was used to gather the data. After encoding, the data was input into SPSS version 22. For qualitative variables, mean and standard deviation were computed, whereas for quantitative variables, frequencies and percentages were determined., p.value? 0.05 was considered significant. The findings were displayed as tables, charts, and figures. Results: Out of 127 participants, 63.7% (n=81/127) were in favor of consultation with the patient's physician before dental extractions whereas 59% (n=75/127) considered discontinuation of aspirin seven days before extractions. Different international normalized ratio (INR) levels were considered for different medical conditions by 78.7% (n=100/127) while 49.6% (n=63/127) of the participants believed that warfarin should be replaced with low molecular weight heparin before dental extractions. 79% of participants knew the antidote of heparin. Postoperative clot formation was not checked by 25.2% (n=32/127), and 87.4% (n=111/127) gave both verbal and written instructions after dental extractions. Conclusion: It is concluded that there is a good level of awareness and implementation of guidance among dental practitioners. Further research and training programs are advised to enhance the knowledge among dental practitioners and to upgrade the standard protocols for treating patients with anticoagulation therapy.

Dentistry and thromboembolic risk: Strategies for effective patient care

Thromboembolic events represent a significant healthcare concern, encompassing conditions such as deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction. The management of patients with a history of thromboembolic events in the dental setting requires careful consideration and collaboration between dentists and healthcare providers. This review article delves into the intricate relationship between thromboembolic events and dentistry.We explore the importance of patient assessment, emphasizing the need for a comprehensive evaluation of medical history, risk factors, and medication regimens. Special attention is given to anticoagulant therapy, and the role of International Normalized Ratio (INR) monitoring in maintaining safe levels of anticoagulation during dental procedures. We discuss the critical timing of dental interventions and the use of local hemostatic measures to minimize bleeding risk.By elucidating these key aspects, this review article aims to provide dental professionals with a comprehensive understanding of thromboembolic events in dentistry, fostering safe and effective oral healthcare for this patient population.

The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation.

Background Patients taking oral anticoagulants (OACs) and oral antiplatelets (OAPs) have a risk of post-operative bleeding when dental extractions are required. Guidance exists to assist dental practitioners on how best to clinically manage these patients, but this is based upon low-quality evidence. The current service evaluation provides real world clinical data when these drugs are not discontinued for oral surgery procedures.Materials and methods All OACs and OAPs were continued and patients requiring dental extractions had local haemostatic measures (local anaesthesia with adrenaline, socket packing with haemostat and resorbable sutures). All patients were offered a follow-up via a telephone clinic service after surgery to assess any post-operative bleeding.Results A total of 439 patients underwent 513 surgical episodes, equating to 1,001 dental extractions. Overall, 412 (95.9%) patients reported no post-operative bleeding complications. A total of 18 (4.1%) patients reported post-operative bleeding requiring further intervention. All but two patients were managed with local haemostatic measures, and no patient required hospital admission. For the single novel OAC cohort of patients, 8/185 (4.3%) procedures had post-operative bleeding.Conclusion This current service evaluation highlights that the risk of significant or life-threatening bleeding following dental extraction when OACs or OAPs are continued remains rare.

Risk of bleeding in patients on single and dual antiplatelet therapy undergoing dental extractions

We assessed the impact of single and dual antiplatelet therapy on postoperative bleeding in dental extraction patients. The study involved 160 patients on antiplatelet medication and a control group of 105 healthy subjects undergoing extractions. Bleeding was considered an "event" if it persisted over 12 hours or met other specific criteria. A total of 115 teeth were extracted from control, 48 teeth were extracted from the dual drug group and 122 from the single drug group, with no significant difference in postoperative bleeding incidence (χ2 = 4.3, p = 0.11). Dental extractions for patients on single or dual antiplatelet therapy can be performed safely using local haemostatic measures without treatment interruption.

Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis

The surgical dental treatment of subjects admitted for anticoagulants therapy represents a consistent risk for peri-operative bleeding. The aim of the present study was to investigate the clinical findings of dental surgery operative management of the patients under anticoagulants drugs protocol. The literature screening was performed using Pubmed/Medline, EMBASE and Cochrane library, considering only randomized clinical trials (RCTs) papers. No limitations about the publication's period, follow-up time or clinical parameters were considered. A total of eight RCTs were included for the qualitative synthesis. No thromboembolic complications were reported in any studies. Several bleeding episodes associated with anticoagulant drugs in dental surgery were mild and generally happened on the first day after the treatment. The use of local haemostatic measures is generally effective for bleeding control with no further pharmacological drug management or suspension.

A retrospective study to identify the compliance with SDCEP guidelines of exodontia patients taking oral anticoagulant and antiplatelet medication

AbstractIntroductionExodontia treatment plans for oral anticoagulant and antiplatelet patients should consider Scottish Dental Clinical Effectiveness Programme (SDCEP) management guidelines. No previous literature has identified SDCEP guidelines compliance. The aim of this study was to determine how Oral Surgery staff manage exodontia patients who take antithrombotic medication, and the extent to which management principles consider SDCEP guidelines.Materials and MethodsAll clinical records were retrospectively analysed to identify patients who matched our criteria and had an exodontia procedure undertaken at Birmingham Dental Hospital over a 3‐month period.ResultsInitial records (n = 2961) of exodontia patients identified that 7.8% (n = 231) of patients were taking oral antithrombotic medication; 163 patients on Antiplatelet medication, 42 on Novel Oral Anticoagulants (NOAC) and 24 on Warfarin. No Antiplatelet or Warfarin patient had their medication regime interrupted. All Warfarin patients had their INR performed and recorded within 72 h of the procedure. A notable difference was found between managing high and low‐risk bleeding procedures for NOAC patients, although this was not statistically significant. Local intra‐operative haemostatic measures applied were significantly different between each of the drug groups (p < 0.001). No local haemostatic measures were recorded in 45% of Antiplatelet patients, compared to 4.8% of NOAC and 12.5% of Warfarin cases. Self‐referrals are presented more commonly on a Thursday or Friday (p = 0.037).ConclusionsEach treatment plan should be considered on an individual basis, combining clinician expertise and clinical guidelines to optimise patient care. Areas of poor compliance were identified with further research being required to comprehend how compliance with the literature alters post‐operative haemostatic complications.

Complications and treatment errors in nonsurgical periodontal therapy.

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Hemostatic Agents for the Management of Bleeding Risk Associated with Oral Anticoagulant Therapy Following Tooth Extraction: A Systematic Review

The occurrence of bleeding following dental extraction is a relatively common complication. A history of therapy with oral anticoagulants represents a major favoring factor, both in patients treated with vitamin K-antagonists (especially warfarin) and with direct oral anticoagulants (DOACs). Several local hemostatic measures can be applied to limit the bleeding risk in these patients. The aim of this systematic review is to evaluate what measures can be adopted to limit the bleeding risk following dental extractions in patients treated with oral anticoagulants. A literature search was performed, and 116 articles were retrieved. Titles and abstract analyses excluded 91 articles, and three more articles were excluded following full-text analysis. The systematic review was performed on 22 articles. Among the included articles, 20 studies reported on patients treated with warfarin, and two studies on patients treated with DOACs. The agents employed included local intra-alveolar agents, tranexamic acid, and PRF. The included studies were all at moderate/high risk of bias. Moreover, limited evidence is available on hemostasis in patients treated with DOACs. The available evidence hinders stating the superiority of one agent over the others. Further research is advised to increase the level of evidence of the application of hemostatic agents in patients treated with oral anticoagulants.

Should we stop dual anti-platelet therapy for dental extractions? An umbrella review for this dental dilemma

ObjectivesDual Anti-platelet Therapy (DAPT) are prescribed to patients who had or are at risk of cerebrovascular or cardiovascular ischemic events. This umbrella review appraises existing systematic reviews on the risk of bleeding related complications during and after dental extractions for patients on DAPT. Study Data and SourcesThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered to the PROSPERO (International prospective register of systematic reviews) database. A systematic electronic literature search was conducted according to the PRISMA guidelines, via PubMed, Ovid, Cochrane and Embase. Study SelectionFour systematic reviews met the inclusion criteria and were included the analysis. They show DAPT increases the risk of bleeding related complications after dental extractions, but the differences may not be clinically significant as local haemostatic measures were adequate in controlling bleeding. ConclusionDespite the increased risk of bleeding after dental extractions in patients on DAPT, it may not be necessary to interrupt the anti-platelet therapy. Local haemostatic agents may be sufficient in controlling both the primary or secondary bleeding. On the other hand, the complications of discontinuing DAPT may be more severe and fatal.

Comparative Risk of Bleeding of Anticoagulant Therapy with Vitamin K Antagonists (VKAs) and with Non-Vitamin K Antagonists in Patients Undergoing Dental Surgery.

Objectives: A wide variety of approaches have been proposed to manage anticoagulant drugs in patients undergoing dental surgery; vitamin K antagonists and novel direct oral anticoagulants have been used. The present study aims to explore the existing evidence concerning the management of patients in anticoagulant therapy undergoing oral surgery procedures and to give suggestions related to peri- and post-operative measures. Materials and methods: A comprehensive search of databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The present scoping review was realized in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The publications varied from randomized controlled trials (RCT) to cohort trials. Only articles written in English language and published between 2000 to 2020 were screened. The studies were included if discussing the management of a patient in anticoagulant therapy (warfarin or direct oral anticoagulants) scheduled for tooth extraction. Results: 33 studies were selected and included in the qualitative review. Nineteen considered anticoagulant therapy with warfarin, six considered anticoagulant therapy with new oral anticoagulants and eight compared patients taking warfarin with patients taking direct oral anticoagulants. Conclusions: No case of extractive surgery should alter the posology of the drug: thromboembolic risks derived from discontinuation are heavier than hemorrhagic risks. Clinical relevance: direct oral anticoagulants are safer in terms of bleeding and manageability and bleeding episodes are manageable with local hemostatic measures.

Risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs - A case control study

Background/purposePatients receiving antithrombotic drugs are more likely to suffer bleeding after tooth extraction and multiple factors are related to it. The aim of this study was to investigate the incidence of bleeding and risk factors for bleeding after dental extractions in patients receiving antithrombotic drugs. Materials and methodsThis retrospective case control study included patients receiving oral antithrombotic drugs or not. Tooth extractions were conducted under ECG monitoring and local hemostatic measures were performed. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. ResultsBleeding events were reported in 27 (27%) patients receiving antithrombotic drugs and 9 (9%) patients who didn't use antithrombotic drugs, the difference between which was significant (p < 0.01). Univariate analyses showed that age (OR = 2.717, p = 0.028), oral hygiene (OR = 4.110, p = 0.043), inferior nerve block (OR = 4.285, p = 0.038) and number of extracted tooth (OR = 4.758, p = 0.029) were significantly correlate with bleeding incidence. Multivariate analysis revealed that age (OR = 2.824, p = 0.036) and number of extracted tooth (OR = 5.268, p = 0.016) were significant risk factors for postextraction bleeding. ConclusionThe results suggest that there is higher incidence of postextraction bleeding in patients receiving antithrombotic drugs compared to patients who don't. Age (>75 years), oral hygiene, inferior nerve block and number of extracted tooth may be related to bleeding after tooth extraction.

English

The incidence of thromboembolic diseases is high. It is one of the leading causes of death and disability. Anticoagulants are used for preventing or reducing blood clot formation and treatment of other related thrombotic disorders. Vitamin K antagonists (VKA) were developed more than 60 years ago. Warfarin is the most commonly used VKA. The drawbacks of vitamin K antagonists were that it requires frequent monitoring and dose adjustments, food and drug interactions, narrow therapeutic range, diet restrictions. For the past 15 years, various new drugs have been introduced to overcome the disadvantages of vitamin K antagonists. In 2008, a new group of anticoagulants were introduced. They are known as novel anticoagulants (NOAC) or direct oral anticoagulants. They include dabigatran, apixaban, rivaroxaban and edoxaban. The major issue with NOAC is difficulty in monitoring the dose. A literature search was done on this topic. It is very important for the dentists to know the bleeding complications in patients under anticoagulant therapy. The dental treatment of patients who tend to have an increased risk of bleeding due to the use of anticoagulants and / or antiplatelet drugs raises a challenge in the daily practice of dental professionals. According to current evidence, there is no significant difference in postoperative bleeding between novel anticoagulants and vitamin K antagonists. The risk of thromboembolic events on stopping the anticoagulants should be assessed. Local haemostatic measures are shown to suffice to control possible bleeding secondary to dental treatments. KEY WORDS Anticoagulants; Apixaban; Dabigatran; Dentistry; Edoxaban; Rivaroxaban.

Dental implants and risk of bleeding in patients on oral anticoagulants: a systematic review and meta-analysis

BackgroundDental implant placement is safe and predictable, yet optimal management of anticoagulated patients remains controversial. Whilst cessation of anticoagulation pre-operatively should decrease risks of bleeding, risk of thrombosis increases. We aim to define risk of bleeding in patients on oral anticoagulation who are undergoing dental implant placement, in order to establish best management.MethodsThis systematic review is registered with the National Institute for Health Research (NIHR) PROSPERO database (Registration No: CRD42021233929). We performed a systematic review as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Studies were identified using an agreed search strategy within the OVID Gateway (this included Pubmed, MEDLINE, Cochrane Collaborative). Studies assessing bleeding complications in patients who were undergoing dental implant placement were selected. The primary outcome was bleeding events in anticoagulated patients undergoing dental implant placement. Secondary outcomes included any complication requiring further intervention.ResultsWe identified 182 studies through screening, and after review of titles and abstracts reduced this to 8 studies. In these studies, 1467 participants received at least 2366 implants. Studies were analysed for quality using the ROBINS-I risk of bias tool. Four studies were retrospective case reviews, and four were prospective reviews, three of which also blinded the operator to anticoagulation status. There was significant heterogeneity between the included studies. Meta-analysis showed an increased risk of bleeding (RR, 2.30; 95% CI, 1.25-4.24 p = 0.37 I = 7%) when implants were placed in the presence of anticoagulation however these were not clinically significant haemorrhagic events.ConclusionThe continuation of anticoagulants peri-operatively during dental implant surgery does increase the risk of clinically non-significant peri- and post-operative bleeding. Dental implant surgery encompasses a broad spectrum of procedures ranging from minor to more invasive surgery with simple local haemostatic measures mitigating the risk of bleeding. The decision to discontinue anticoagulants prior to dental implant surgery must consider patient and surgical factors with the clinician undertaking a risk-balance assessment.

Surgical procedures in patients on aspirin. Literature Review

Aspirin is referred to as the original of the common non-steroid anti-inflammatory drugs and is used as a comparison measure to new ones. Aspirin, whose active ingredient is acetylsalicylic acid, combines strong antipyretic, analgesic, anti-inflammatory and anti-coagulant action. For the latter, aspirin is administered on an ongoing basis to patients for the prevention of cardiovascular events or recurrence of cerebral throm- bosis and therapeutically to patients with a history of heart attack or ischemic stroke. Taking aspirin as an anticoagulant chronic medication concerns dentists es- pecially when it comes to surgical procedures as it is likely to cause increased bleeding perioperatively. The management of the patient on aspirin varies depending on the reason aspirin is administered and its dosage, the co-administration of other antiplatelet or anticoagulant drugs and the severity of the surgical procedure itself. An interruption of antiplatelet medication is decided after assessing the above-mentioned criteria and con- sulting the patient’s physician. Additionally, in cases of increased bleeding risk like complex extractions, pre- prosthetic surgery, periodontal surgery, the procedure needs to be performed as atraumatically as possible and be accompanied by local haemostatic measures.

Evaluating the Need of Continuing the Antiplatelet Drug Therapy in Patients Undergoing Minor Oral Surgical Procedures

Background:Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications, whereas continuation leads to increased postoperative bleeding.Aim:We conducted this prospective cross-sectional study to assess risk of bleeding in patients continuing antiplatelet medication while performing minor oral surgical procedures such as single or multiple teeth extraction, transalveolar extraction of third molar, biopsy, and alveoloplasty.Materials and Methods:We calibrated the steps taken to achieve hemostasis, time taken to arrest bleeding, and correlated time taken to achieve hemostasis in patients under antiplatelet drug therapy (Group A [n = 64] - aspirin, Group B [n = 36] - aspirin and clopidogrel) and in patients without any drug therapy (Group C [n = 100] healthy patients).Results:Out of 200 patients, Level 1 hemostatic measures were required for 129 (64.5%) patients, Level 2 hemostatic measures were taken for 68 (34.0%) patients, and Level 3 hemostatic measures were taken for 3 (1.5%) patients. Chi-square test conducted to compare the local hemostatic measures taken for minor oral surgical procedure for all groups was statistically significant (P ≤ 0.001).Conclusion:Overall, there was no postoperative bleeding within 24 h of extraction in any patient group. In conclusion, surgical procedures can be safely accomplished in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken.

Prospective observational study on the clinical behaviour of dental implants in patients with haemophilia. Preliminary results

Haemophilia is a recessive congenital hereditary haemorrhagic disorder characterised by the decrease in, or absence of, the functional activity of factor VIII (Haemophilia A) or factor IX (Haemophilia B). The haematological medical treatment for these patients is systemic replacement therapy with factor VIII or factor IX concentrates. Dental implants are considered the gold standard for the replacement of missing teeth. There is no evidence or safe protocol for their use in patients with haemophilia. The objective of this study was to evaluate the clinical osseointegration and the incidence of postoperative bleeding in patients with haemophilia. The patients included in this study were over 18 years old with a diagnosis of haemophilia. A surgical implant protocol was implemented, supported by systemic and local haemostatic measures. Age, type of haemophilia, pre- and post-factor levels, gingival index, surgical duration, oedema, and pain were recorded for each case. In the event of haemorrhage, the bleeding index was determined. At four months, the success of the implant was evaluated using the absence of pain, suppuration, and clinical mobility as parameters. Fifteen surgeries were performed and 21 implants were placed in 10 patients. All the implants were successful in terms of the evaluated parameters. Among the 15 surgeries performed, bleeding was detected in three. The preliminary results found in this study seem to establish that the proposed surgical implant and haemostatic protocol is a predictable treatment for the placement of dental implants in patients with haemophilia.