Proposal of a standard approach to dental extraction in haemophilia patients. A case-control study with good results

We found no case-control studies on dental extraction in haemophilia patien ts in the literature even though the use of antifibrinolytic agents followi ng a single infusion of factor VIII or IX has been accompanied by a lower n umber of bleeding complications in dental extractions. In this study we ver ified the incidence of bleeding complications after dental extraction in a group of 77 haemophilia patients. One hundred and eighty-four male patients requiring dental extraction represented the control group. All haemophilia patients received 20 mg kg(-1) of tranexamic acid and a single infusion of factor VIII or IX to achieve a peak level about 30% of factor VIII or IX i n vivo prior to dental extraction. Forty-five of 98 (45.9%) dental extracti ons in haemophilia patients and 110 of 239 (46%) dental extractions in the control group were surgical ones. We registered two bleeding complications in the group of haemophilia patients (one late bleeding and one haematoma i n the site of the anaesthetic injection) and one (a late bleeding) in the c ontrol group. The difference of bleeding complications in the two groups of patients were not statistically significant (P = 0.2; OR 0.2; CI 0.01-2.22 ). The protocol proposed in this study, characterized by the feasibility an d the number of haemorrhagic complications not different from normal popula tion, make dental extractions in haemophilia patients possible on an out-pa tient basis with a cost reduction for the community and minor discomfort fo r the patients.