Faculty of Medicine Novi Sad, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia.
Special Care Dentistry Division of Child and Public Dental Health, School of Dental Science, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland.
Haemophilia. 2020 Mar;26(2):183-199. doi: 10.1111/hae.13928. Epub 2020 Jan 21.
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.
由于口腔疾病在全球范围内普遍存在，拔牙是普通人群中最常见的手术，因此在血友病患者中也可能同样常见，尤其是年龄较大的患者和资源有限的国家的患者。关于手术后预防出血并发症所需的最佳因子替代（FRP）治疗水平和持续时间，几乎没有或没有共识，也几乎没有证据来告知方案和指南。本文的目的是回顾有关血液学治疗方案的文献，并评估其在预防血友病患者拔牙过程中和拔牙后出血并发症方面的有效性。共确定了 29 篇文章。只有两项研究是随机对照试验，无法进行荟萃分析。发表的研究在血液学方案、牙科手术程序、疾病严重程度和样本量方面存在显著异质性，这些研究无法可靠地告知安全牙科手术的提供。根据血液学方案，所有研究都分为三组之一：术前和术后 FRP 或 DDAVP、单次术前 FRP 或 DDAVP 和无 FRP 治疗。在术前和术后 FRP 以及单次剂量 FRP 的情况下，报告的总体出血率相似，分别为 11.9%和 11.4%，这表明如果提供适当的局部止血措施，则可以尽量减少凝血因子浓缩物的使用。需要进行严格设计的前瞻性研究，纳入更多患者，才能就血友病患者口腔手术后预防出血并发症所需的最佳 FRP 治疗得出明确结论。
