Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery

Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy H. T.; Minno, Matteo Nicola Dario Di

doi:10.1002/14651858.cd009961.pub2

Cited by 46 publications

(58 citation statements)

References 59 publications

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“…46 It should be noted that evidence-based approaches of haemostatic treatment from randomized trials are virtually lacking in all types of surgery in PWH; indeed, a later Cochrane review in 2015 identified only 4 RCTs, among which 2 were studies investigating the role of antifibrinolytic agents in dental surgery. 47 In PWH and the use of a variety of local haemostatic agents and measures, such as sutures to stabilize the wound, minimize the amount of FRP required. The successful use of scaffolding agents to promote platelet adhesion, such as oxidized cellulose, absorbable gelatine and collagen sponges, or the use of fibrin glue after dental surgery, is often described within the literature.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…A recent Cochrane review has emphasized the lack of post‐operative data on bleeding complications in the bleeding disorder patient population . Notwithstanding this generic call for data, we also propose that a registry should be established in order to collate the broad and specific essential multivariate outcomes in inhibitor‐positive patients.…”

Section: Discussionmentioning

confidence: 99%

Over two decades of orthopaedic surgery in patients with inhibitors—Quantifying the complication of bleeding

et al. 2018

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Patients with haemophilia who have developed inhibitors against factor VIII (FVIII) or factor IX present a significant concern to those surgeons who operate on them. The evidence base for bypassing agents such as recombinant factor VIIa and activated prothrombin complex concentrate has amassed over several decades. The literature is open to positive interpretation on the successful use of these agents in the treatment of inhibitor‐positive patients. However, there are equally persistent concerns amongst surgeons, in particular orthopaedic surgeons, regarding the high complication rate of bleeding. To explore and quantify this concern, we present a literature review spanning two decades of publications on haemophilia patients with inhibitors undergoing orthopaedic surgery. Irrespective of the progress made with haemostatic protocols, trepidation on embarking on surgery is valid. The high risk of bleeding is a function of the inherent complexity of the disease and rightfully translates into difficulties in its management. Combined with the prospect of orthopaedic surgery, those involved in the care of such patients are justified in their continued anxiety and diligence when considering the benefits in quality of life against the prevalent complications.

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“…To decrease surgical complications, avoid prolonged hospitalization, and decrease morbidity and mortality in these individuals, haemostatic treatment is used prior to invasive surgical procedures . Individualized pre‐operative treatment based on the type of bleeding disorder and the type of surgical procedure is vital to provide optimal treatment for patients with bleeding disorders undergoing surgery . However, haemostasis treatment plans can be complicated, requiring frequent monitoring of coagulation labs, assuring availability of haemostatic medications and anticipating blood product administration.…”

Section: Introductionmentioning

confidence: 99%

Managing paediatric bleeding disorder patients undergoing surgical procedures: Leveraging the electronic medical record

et al. 2018

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Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery

Cited by 46 publications

References 59 publications

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

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

Over two decades of orthopaedic surgery in patients with inhibitors—Quantifying the complication of bleeding

Managing paediatric bleeding disorder patients undergoing surgical procedures: Leveraging the electronic medical record

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