Further Experience in Use of Human Antihæmophilic Globulin (H.A.H.G.) for the Control of Bleeding After Dental Extraction in Hæmophilic Patients

Biggs, Rosemary; Matthews, J. M.; Rush, B M; Johnstone, Fiona; Macfarlane, Robert; Hayton-Williams, D.S.

doi:10.1016/s0140-6736(65)91213-4

Cited by 28 publications

(16 citation statements)

References 5 publications

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“…Christmas factor (Biggs et al, 1961). Despite attempts to establish minimal dosage regimes for administration of therapeutic materials (Biggs et al, 1965)~ it is often considered necessary to treat most patients for 7-10 days or longer with daily infusions of plasma or plasma derivatives. To conserve supplies of therapeutic materials and to decrease the possibility of transmitting hepatitis and other diseases with blood products, it is desirable to reduce the amounts of blood products used if this is safe.…”

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confidence: 99%

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

et al. 1971

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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.

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

et al. 1971

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“…In a total number of 394 patients who were treated with pre‐ and postoperative FRP or DDAVP and who underwent oral surgical procedures, mostly dental extractions (more than 1368 tooth extraction), in more than 486 treatment sessions, the overall reported bleeding rate is 104/486 (21.4%) in a range 3.9%‐45%. The high incidence of bleeding in this group was mostly because of the results of three older studies when plasma or cryoprecipitate was used for FRP and local haemostatic measures were not widely applied. Where we exclude those three studies from the analyses, the overall reported bleeding rate is 38/319 (11.9%) in a range 3.9%‐27.8%…”

Section: Resultsmentioning

confidence: 99%

Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Bajkin

Dougall

2020

Haemophilia

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Due to the global prevalence of oral disease, tooth extraction is the most common surgical procedure required in general population thus likely to be similarly common in patients with haemophilia, especially those in older age and those living in countries with restricted resources. There are little or no consensus about optimal level and duration of factor replacement (FRP) therapy required to prevent bleeding complication following surgery and low levels of evidence to inform protocols and guidelines. The goal of this article was to review the literature regarding haematological treatment protocols and to assess their effectiveness in prevention of bleeding complications during and after tooth extractions in people with haemophilia. A total number of 29 articles were identified. Only two of the studies were randomized controlled trials, and meta‐analysis was not possible. Significant heterogeneity regarding haematological regimes, dental surgical procedures, disease severity and sample size of published studies which are unable to reliably inform the provision of safe dental surgery was noted. Based on the haematological regimens, all studies were classified into one of three groups: pre‐ and postoperative FRP or DDAVP, single preoperative FRP or DDAVP, and no FRP treatment. The overall reported bleeding rate in case of both pre‐ and postoperative FRP and single dose FRP preoperative is similar, 11.9% and 11.4%, respectively, indicating that minimizing the use of clotting factor concentrate is possible if proper local haemostatic measures are provided. Strictly designed prospective studies with higher number of patients are necessary to get firm conclusions about optimal FRP treatment required to prevent bleeding complications during and after oral surgery in patients with haemophilia.

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“…The present generally accepted regimen involves frequent transfusions of fresh frozen plasma combined with the local use of dental splints to protect the sockets, which are packed with oxidized cellulose soaked in bovine thrombin. Antihaemophilic globulin concentrates of human, bovine, or porcine origin have also been used with considerable success (Macfarlane et al, 1954 ;Biggs et al, 1965). Lucas et al (1962) advocated the use of hypnosis, combined with extensive local measures, as a means of obtaining haemostasis without the need of replacement therapy.…”

Section: Preliminary Communicationsmentioning

confidence: 99%

Epsilon-aminocaproic acid therapy for dental extractions in haemophiliacs.

Cooksey¹,

Perry²,

Raper³

1966

BMJ

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Further Experience in Use of Human Antihæmophilic Globulin (H.A.H.G.) for the Control of Bleeding After Dental Extraction in Hæmophilic Patients

Cited by 28 publications

References 5 publications

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

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

Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence‐based practice? A review of the literature

Epsilon-aminocaproic acid therapy for dental extractions in haemophiliacs.

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