Background: Dental extractions challenge the body’s haemostatic

mechanism. Postoperative bleeding from extraction sockets can be

prolonged, or even life-threatening in patients with inherited bleeding

disorder. Pre- and post-operative clotting factor replacements or

systemic ddAVP have been advocated and employed at the Royal

Brisbane & Women’s Hospital (RBWH) to prevent bleeding complications

in these patients. This approach can be time-consuming, expensive,

limits patients to receive extractions as a hospital inpatient and is

associated with complications such as development of clotting factor

inhibitors.

Objectives: To assess the post-operative bleeding rate in patients

with inherited bleeding disorder that underwent dental extractions

at the RBWH between 2003-2012 with peri-operative clotting factor

replacement or systemic ddAVP cover.

Method: Patients with inherited bleeding disorder such as Haemophilia

A, Haemophilia B and von Willebrand’s disease were included. Chart

review was conducted and the following information was extracted: type

and severity of inherited bleeding disorder, number of teeth extracted, if

bone removal was required, if haemostatic agent was placed within the

socket, the type and amount of clotting factor and ddAVP used pre and

post-operatively, and if significant post-operative bleeding occurred.

Findings: 53 extraction events occurred in 45 patients between

2003-2012. All patients had peri-operative clotting factor or systemic

ddAVP cover. 10 out of 53 extraction events (18.9%) had post-operative

bleeding requiring further factor replacement or ddAVP. Post-operative

bleeding in 1 patient with mild Haemophilia A was complicated by the

development of inhibitors. Type and severity of bleeding disorder, bone

removal and use of local haemostatic agent did not have any significant

effect on post-operative bleeding.

Conclusion: Despite the use of peri-operative factor and ddAVP,

post-operative bleeding rate remains high for patients with inherited

bleeding disorder. More study is required to assess the effect of using

local haemostatic control to achieve haemostasis following extractions

in these patients.