Epsilon‐Aminocaproic Acid Therapy for Dental Extractions in Haemophilia and Christmas Disease: A Double Blind Controlled Trial

Abstract

Summary. The results are reported of a pilot study and two separate double blind controlled trials of the effectiveness of epsilon‐aminocaproic acid (EACA) in dental extractions in patients with haemophilia and Christmas disease. In the major trial 31 patients were studied; 23 at Oxford and eight at Cardiff. All patients received either EACA (6 g four times daily for 10 days at Oxford or for 7 days at Cardiff) or a placebo, in conjunction with a single preoperative dose of therapeutic materials expected to raise the plasma factor‐VIII or factor‐IX level to 50%. Post‐operative therapeutic materials were withheld unless intraoral bleeding occurred. Despite the fact that plasma factor‐VIII or factor‐IX levels were, on average, lower, the number of teeth extracted larger, the amount of therapeutic concentrates less and the postinfusion plasma factor‐VIII or factor‐IX levels lower in the EACA group at Oxford, the incidence of postoperative intraoral bleeding was lower and the requirements for postoperative therapeutic materials less in the group treated with EACA. Side‐effects were not a major problem. The number of patients studied at Cardiff was too few for statistical analysis but the results were similar to those at Oxford. The total conservation of therapeutic materials at Oxford in comparison to the amount utilized before EACA was used is estimated on the basis of these results to be approximately 12 000 factor‐VIII or factor‐IX units/patient, or approximately 190 units/kg/patient, equivalent, for each patient, to the amount derived from approximately 120 blood donations. These results show that EACA in conjunction with preoperative therapeutic concentrates sufficient to raise the plasma factor‐VIII or factor‐IX level to 50% can be useful for all patients with haemophilia and Christmas disease undergoing tooth extraction. In some patients EACA therapy is contraindicated and for these patients adequate cover with therapeutic materials must be provided during the postoperative period.

Ultra-Early Hemostatic Therapy for Intracerebral Hemorrhage

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Regulation of Fibrinolysis by Thrombin Activatable Fibrinolysis Inhibitor, an Unstable Carboxypeptidase B That Unites the Pathways of Coagulation and Fibrinolysis

“…Indeed, in a controlled trial of antifibrinolytic therapy in hemophilia, patients undergoing dental extractions characteristically bled from tooth sockets after 3 to 5 days, whereas bleeding was completely prevented in patients receiving the antifibrinolytic agent -aminocaproic acid (ACA). 72 This lysine analogue acts very similar to TAFIa in that it inhibits plasmin formation by preventing the binding of plasminogen to C-terminal Lysine residues on partially degraded fibrin that are required for efficient plasmin formation. These observations support the idea that the severe bleeding disorder in hemophilia patients may be attributable to triple defect: (1) reduced thrombin generation via the extrinsic pathway at low tissue factor concentrations; (2) a reduced secondary burst of thrombin generation via the intrinsic pathway, and (3) a defective downregulation of the fibrinolytic system by the intrinsic pathway.…”

Management of Various Bleeding Problems in Dental Patients: An Approach to Normal Hemostatic System and the Patient's Specific Coagulation Defect

“…Tranexamic acid in an oral soak helps stop postoperative bleeding from surgical wounds. Postoperative use of epsilon-aminocaproic acid can considerably diminish the level of factor compulsory to control bleeding when used in conjunction with pre surgical infusion of factor VIII concentrate (Webster et al, 1973;Walsh et al, 1971;Walsh et al, 1975). Hemophilia B is the consequence of factor IX deficiency.…”