Optimising local therapy during oral surgery in patients with von Willebrand disease: effective results from a retrospective analysis of 63 cases

Bleeding after dental extractions is very frequent in patients with von Wil lebrand disease (vWD) and in the past often necessitated transfusions with factor VIII/von Willebrand factor concentrates (vWFc). To evaluate the bene fits of a standard local therapy on bleeding complications during oral surg ery, 63 consecutive patients with vWD were analysed retrospectively. All ty pes of vWD were included: type 1 (n = 31), type 2 (n = 22) and type 3 (n = 10). All the patients had dental extractions or periodontal surgery at the same hospital by the same oral surgeons. All cases had been given tranexami c acid (TA) before and for 7 days after surgery. As additional local therap y fibrin glue (FG) was used during surgery in several patients. Additional systemic therapies were: desmopressin (DDAVP, 0.3 mu g kg(-1)) and fVIII/vW F concentrates (vWFc, 40 U kg(-1)) given as a single dose before surgery. T he 29 subjects (46%) treated locally did not bleed. Among the remaining cas es, 24 (38%) were given DDAVP as additional systemic therapy and 6 (9.5%) r eceived vWFc. There was bleeding after surgery in only two cases who had be en given local FG (type 2 B) or systemic vWFc (type 3), but bleeding was st opped with an additional local application of FG. Our data suggest that a s tandard local therapy with TA and FG with DDAVP can prevent bleeding compli cations during oral surgery in the majority of patients (84%) with vWD and reduce the need for concentrates, with all their possible complications and high costs.