Recombinant activated factor VII (rFVIIa), combined with local measures of fibrin glue and a celluloid splint, preventing bleeding from four invasive dental procedures is reported. A single dose of 180-200 micro g/kg was successfully used in three surgical removals of impacted teeth. Four doses of rFVIIa were required in another full mouth treatment of extraction, pulpotomy, filling and the stainless steel crowning of 13 teeth. The repeated dose of rFVIIa was given whenever the bleeding complication was visualized. It is cost-effective for preventing external bleeding. Additionally, an oral rinsing solution of tranexamic acid (25 mg/kg) was given three times a day for 7 days. In conclusion, rFVIIa has been shown to be an effective alternative to platelet concentrate in patients with Glanzmann thrombasthenia.
Controlling haemorrhage by using a celluloid splint as an adjunctive therapy in patients with bleeding disorders is very beneficial in dental extraction. However, this technique still requires specific replacement therapy. The use of fibrin glue as a local treatment in dental extraction, without the use of any blood product replacement, recommended to improve efficiency in controlling haemorrhage during dental extraction. This method was modified using a combination of celluloid splint and fibrin glue for use in dental extraction in bleeding disorder patients. It was found that this method was effective in controlling bleeding, was cost effective, did not require replacement therapy and posed no risk of viral transmission.
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