Fibrinolysis: A possible factor in the control of postoperative hemorrhage in the patient with hemophilia

doi:10.1016/0030-4220(73)90237-5

Oral Surgery, Oral Medicine, Oral Pathology

Volume 36, Issue 2, August 1973, Pages 195-200

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(73)90237-5 Get rights and content

Abstract

A peripheral view of the physiologic and pathologic aspects of fibrinolysis as it may relate to postoperative hemorrhage in the hemophilia patient. The authors discuss the efficacy of epsilon-aminocaproic acid therapy in reducing the amount of factor VIII needed to maintain postoperative hemostasis.

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Cited by (14)

A systematic review of complication risks for HIV-positive patients undergoing invasive dental procedures
2002, Journal of the American Dental Association
Citation Excerpt :
Tooth extraction is a common surgical procedure performed on thousands of people every day, many of whom are infected with HIV. Patients with underlying medical diseases, such as hemophilia, liver cirrhosis or immune dysfunction resulting from various causes, may be at higher risk than those with intact hemorrhagic and immune systems.7–9 Thus, it seems that the HIV-infected patient also may be at increased risk.
This systematic literature review determined the strength of evidence regarding whether patients with human immunodeficiency virus, or HIV, are at higher risk of developing complications from invasive oral procedures than similar patients without HIV.
MEDLINE and EMBASE searches of the English literature from the early 1980s through April 2000 yielded five articles meeting the inclusion and exclusion criteria: original research, concurrent treatment of HIV-positive and HIV-negative subjects, presence of complications (for example, local or systemic infection, bleeding, alveolitis, delayed healing) resulting from extractions, orthognathic surgery, periodontal therapy, endodontic therapy, placement of dental implants, prophylaxis, or scaling and root planing.
The authors found no studies involving orthognathic surgery, periodontal therapy, dental implants, prophylaxis, or scaling and root planing, and only one study reporting few immediate endodontic therapeutic complications. Thus, the evidence is insufficient with respect to any additional risk associated with these procedures among people with HIV/AIDS. Because of the few studies, low overall complication rates and variability in results from different analytic approaches, the authors consider the evidence to be too poor to rule in or out a meaningful relationship between HIV status and complications from tooth extractions.
Limited published scientific evidence is available to guide clinicians in regard to possible increased risks of invasive oral procedures associated with the HIV status of the patient.
Dental management of the patient with hemophilia
1988, Oral Surgery, Oral Medicine, Oral Pathology
The combined local/systemic use of antifibrinolytics in hemophiliacs undergoing dental extractions
1985, International Journal of Oral Surgery
A total of 185 permanent teeth were extracted in 43 hemophiliacs. The patient material is divided into 3 groups with respect to antifibrinolytic therapy. Patients in group 1 were given antifibrinolytics systemically. In group 2, antifibrinolytics were applied locally, and in group 3 they were used both locally and systemically. The results of the treatment were evaluated using the number of units per kilogram of F VIII administered per patient and the Coagulum Index (Col). It is shown that local use of antifibrinolytics can reduce the amount of F VIII required for the control of bleeding, but regarding the high values of the Col, the therapeutic effects are unsatisfactory. Approximately 20 U/kg of F VIII per patient, given in single infusion prior to intervention, were required in group 1 as well as in group 3. However, with respect to the Col, a statistically significant difference is found between groups 3 and 1. On this basis, it is concluded that antifibrinolytics, used both locally and systemically, appear to show distinct advantages in the treatment of hemophiliacs undergoing dental extractions and also receiving F VIII therapy.
Dental extractions in hemophilia: Reflections on 10 years' experience
1985, Oral Surgery, Oral Medicine, Oral Pathology
During the past ten years we have witnessed a remarkable reduction in complications following dental extractions in patients with hemophilia. Thirty-six of 100 patients experienced delayed bleeding during the first half of this period; fourteen of 112 patients had a hemorrhagic problem after extraction during the second half. From a major undertaking involving hospitalization and general anesthesia, it has become a simple procedure in the outpatient office. During the entire period, no changes were made in the transfusion policy or in the oral administration of antifibrinolytic agents. Factors contributing to the favorable evolution have been the increasing experience of the oral surgeon, the improving dental status of our hemophilia patients, prophylactic measures to reduce gingival inflammation, and changes in the composition and amount of material used to pack the dental sockets.
Severe hemorrhage as an endodontic complication
1977, Journal of Endodontics
Tooth extractions in hemophiliacs
1975, International Journal of Oral Surgery
Patients with tendency to bleed can raise considerable problems in oral surgery. A total of 264 teeth and root stumps were extracted in 67 patients with hemophilia A, hemophilia B and von Willebrand's disease in 118 treatment sessions. An additional four patients with rare coagulation defects were treated. The patient material is divided into three groups in respect to therapy. Patients in Group 1 were given substitution therapy only in connection with the extractions. In Group 2 this form of treatment was supported by fibrinolytic inhibitors and antibiotics, and in Group 3 local hemostatic treatment of the alveolus and acrylic splints were added. It is shown how the substitution therapy and the number of hospitalization days can be markedly reduced, and the postoperative bleedings lessened by changing from treatment according to Group 1 to Group 2, respectively Group 3. It is pointed out that the coagulum formed in the alveolus must be protected from traumatic influence and against the unfavorable influence of saliva by using acrylic splints. Finally, the importance of decreasing local proteolysis through fibrinolytic inhibitors and of reducing postoperative infections by the use of antibiotics has been emphasized.

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^☆: The opinions or assertions contained in this paper are those of the authors and are not to be construed as official or as reflecting the views of the Air Force.

^∗: Oral Surgeon, Dental Sciences Branch, USAF School of Aerospace Medicine, Brooks Air Force Base, Texas. Formerly Resident in Oral Surgery, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas.

^∗∗: Chairman, Department of Oral Surgery.

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Fibrinolysis: A possible factor in the control of postoperative hemorrhage in the patient with hemophilia☆

Abstract

Am. J. Surg

Med. Clin. North Am

Am. J. Surg

Oral Surg

Br. J. Oral Surg

Oral Surg

J. Pediatr

Oral Surg

Oral Surg

J. Pediatr

The Pharmacological Basis of Therapeutics

Lipids, Blood Coagulation, and Fibrinolysis

Ann. Rev. Med

Fibrinolysis

N. Engl. J. Med

Evaluation of the Hemostatic Mechanism

Med. Clin. North Am

Fibrinolysis

Ann. Rev. Med

Platelet Function. I

N. Engl. J. Med

Platelet Function. II

N. Engl. J. Med