Local Fibrinolysis in the Oral Cavity

Abstract

In vitro tissue culture has shown that plasminogen activators are released both from normal and from pathological mucous membrane in the oral cavity. Immunological study (Ljungnér et al 1983) has shown that the plasminogen activators in the mucosa of the mouth are not urokinase in character. Increased local fibrinolytic activity, causing post‐operative bleeding, is a serious complication in patients with hemophilia or other bleeding disorders. The occurrence of pathologically increased local fibrinolytic activity can be prevented and the risk of post‐operative bleeding reduced by the administration of epsilon‐amino‐caproic acid (EACA) or tranexamic acid (AMCA). In 72 hemophilia patients, from whom 191 teeth were extracted, satisfactory results were achieved with but a simple dose of factor VIII and IX per patient in combination with the administration of tranexamic acid. In connection with oral surgery in a number of paitents with mild hemophilia A or mild von Willebrand's disease, the synthetic vasopressin derivative DDAVP has been used instead of factor concentrate. In connection with tranexamic acid, it enabled teeth to be extracted without any post‐operative bleeding complications.

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

“…In most studies concerned with dental extractions in PWH, patients with inhibitors were either excluded from the studies or there were no patients with inhibitors in the studies or it is not specified whether they were included at all . The total number of patients with inhibitors throughout all of the reviewed studies remains very small, <25 . The details of treatment of patients with inhibitors are often not clearly presented especially concerning level of inhibitors, the treatment protocols, the number of teeth removed and frequency of bleeding complications.…”

“…Relatively newer local haemostatic agents, such as Floseal and TachoCom, were used in recent published studies . Most authors advocated wound suturing to approximate the wound edges and reduce trauma from eating chewing forces, and in some studies, primary wound closure that required osteotomy were performed …”

“…In most studies, target levels of 30%‐50% as a single treatment were advocated . Systemic use of antifibrinolytic was part of the perioperative treatment in eleven of those studies . DDAVP was used in patients who respond well in five studies .…”

“…18,[22][23][24][25] Systemic use of antifibrinolytic was part of the perioperative treatment in eleven of those studies. 18,19,22,[24][25][26][27][28][29][30][31] DDAVP was used in patients who respond well in five studies. 19,[22][23][24]28 The level of FRP was not specified in one study.…”

“…18,19,22,[24][25][26][27][28][29][30][31] DDAVP was used in patients who respond well in five studies. 19,[22][23][24]28 The level of FRP was not specified in one study. 32 One further study did not detail the types of dental procedures, or specify the number of tooth extractions, so the results of this study were not analysed regarding bleeding rate.…”