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

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2000-03, Vol.6 (2), p.71-77
• Main Authors: Federici, A B, Sacco, R, Stabile, F, Carpenedo, M, Zingaro, E, Mannucci, P M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Deamino Arginine Vasopressin - administration & dosage; desmopressin; Diagnosis, Differential; Disease Management; Factor VIII - administration & dosage; factor VIII/Willebrand concentrates; Female; Fibrin Tissue Adhesive - administration & dosage; Hemorrhage - etiology; Hemorrhage - prevention & control; Hemostasis - drug effects; Hospitalization; Humans; Male; Middle Aged; Oral Hemorrhage - etiology; Oral Hemorrhage - prevention & control; oral surgery; Oral Surgical Procedures - adverse effects; Periodontal Diseases - complications; Periodontal Diseases - surgery; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Retrospective Studies; Tooth Extraction - adverse effects; tranexamic acid; Tranexamic Acid - administration & dosage; von Willebrand disease; von Willebrand Diseases - complications; von Willebrand Diseases - drug therapy; von Willebrand Diseases - surgery; von Willebrand Factor - administration & dosage
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1046/j.1365-2516.2000.00370.x

Bleeding after dental extractions is very frequent in patients with von Willebrand disease (vWD) and in the past often necessitated transfusions with factor VIII/von Willebrand factor concentrates (vWFc). To evaluate the benefits of a standard local therapy on bleeding complications during oral surgery, 63 consecutive patients with vWD were analysed retrospectively. All types 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 tranexamic acid (TA) before and for 7 days after surgery. As additional local therapy fibrin glue (FG) was used during surgery in several patients. Additional systemic therapies were: desmopressin (DDAVP, 0.3 μg kg–1) and fVIII/vWF concentrates (vWFc, 40 U kg–1) given as a single dose before surgery. The 29 subjects (46%) treated locally did not bleed. Among the remaining cases, 24 (38%) were given DDAVP as additional systemic therapy and 6 (9.5%) received vWFc. There was bleeding after surgery in only two cases who had been given local FG (type 2 B) or systemic vWFc (type 3), but bleeding was stopped with an additional local application of FG. Our data suggest that a standard local therapy with TA and FG with DDAVP can prevent bleeding complications 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.