Risk Factors for Post-Extraction Bleeding in Patients With Haemophilia


 

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  • In this retrospective cohort study, the authors have studied the risk factors for post-extraction bleeding in 55 patients with either haemophilia A (48 patients) or haemophilia B (7 patients). All patients undergoing extractions were given antifibrinolytics and coagulation factor concentrates before extraction in addition to local hemostatic measures such as gelatin sponge, fibrin glue, and/or oxidized cellulose. A mouth splint was also given for 7 days. Unstoppable bleeding even with biting down on gauze and that occurred between 30 minutes and 14 days from the time of extraction requiring medical treatment was defined as post-extraction bleeding.   

  • Post-extraction bleeding was noted in 9 patients (16.3%) averaging on the fifth day after extraction despite systemic and local hemostatic measures. Use of mouth splints was noted to be significantly associated with a reduced risk of post-extraction bleeding. Other factors including severity of hemophilia, factor replacement therapy duration, and bone removal were not found to be significantly associated with post-extraction bleeding.
–  Satish S. Kumar, DMD, MDSc, MS

Many guidelines and studies describe haemostatic management protocols for patients with haemophilia, but few have evaluated the risk factors for post-extraction bleeding. This retrospective cohort study was performed to investigate these risks among this group of patients. We used medical records to identify patients with haemophilia who underwent tooth extraction(s) between April 2006 and April 2019 in the Department of Oral and Maxillofacial Surgery at Nara Medical University Hospital, Nara, Japan, and conducted logistic regression analyses to identify risk or protective factors for post-extraction bleeding in procedures involving factor replacement therapy. Post-extraction bleeding was defined as bleeding that could not be stopped by biting down on gauze, and that required medical treatment between 30min and 14 days after the extraction. A total of 151 extractions (84 interventions) in 55 patients fulfilled the inclusion criteria (130 extractions (72 interventions) in 48 patients with haemophilia A, and 21 extractions (12 interventions) in seven patients with haemophilia B). Post-extraction bleeding was observed in nine patients (16.3%), 10 interventions (11.9%), and 12 extractions (7.9%). On average, it occurred six days after the intervention, and on the fifth postoperative day after extractions. Use of mouth splints significantly reduced the risk (odds ratio: 0.13; p=0.01) in patients on factor replacement therapy. We will conduct a prospective study to investigate the optimal type of splint and optimal splint-wearing period.

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