Preventing perioperative bleeding in patients with inherited bleeding disorders

Area of Science:

• Hematology
• Pharmacology

Background:

• Perioperative bleeding is a significant concern for patients with bleeding disorders undergoing dental procedures.
• Antifibrinolytic agents are used to manage bleeding, but their efficacy in specific patient populations requires robust evidence.

Purpose of the Study:

• To evaluate the effectiveness of antifibrinolytic agents (tranexamic acid and epsilon aminocaproic acid) in preventing perioperative bleeding in patients with hemophilia or von Willebrand disease (VWD) undergoing oral and dental procedures.

Main Methods:

• A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searches included major databases (MEDLINE, PubMed, Embase, Cochrane Library) and clinical trial registries.
• Data extraction and risk of bias assessment were performed independently by two authors.

Main Results:

• Two trials involving 59 participants with hemophilia undergoing dental extraction were included.
• Antifibrinolytic therapy, in addition to factor replacement, significantly reduced post-operative bleeding, blood loss, and the need for additional clotting factors compared to placebo.
• No eligible trials were identified for patients with VWD.

Conclusions:

• Low-quality evidence supports the use of antifibrinolytic therapy as an adjunct for reducing bleeding in hemophilia patients undergoing dental extraction.
• Limitations include the small number and historical nature of the included studies, heterogeneity, and potential selection bias.
• Further high-quality research with standardized designs is needed to strengthen the evidence base for managing hemophilia and VWD patients.