Amna Qureshi, Ambrina Qureshi, Ayyaz A Khan, Hina Qureshi.
Use of antifibrinolytics in the management of true haemophiliacs undergoing dental treatment.
Pak J Pathol Jan ;18(1):31-4.
The basic criteria of treatment of postoperative bleeding in true haemophiliacs undergoing dental treatment can be managed by supportive treatment, local haemostatic measures and an effective replacement therapy prophylactically. It has been reviewed that antifibrinolytics, such as tranexamic acid or epsilon amino caproic acid (EACA) are usually adequate prophylaxis prior to dental treatment. These have been found useful in treating haemophilia A by helping the clot in place once it has been formed. It is known that the underlying cause in true haemophiliacs lies in the deficiency of FVIII and not due to the pathological or raised fibrinolysis, which means that their fibrinolytic system remains intact as in any normal individual provided that these patients are infused with sufficient amount of clotting factor, therefore, the administration of antifibrinolytics is questionable. This article reviews the existing and evident literature in order to simplify the management protocols in true haemophiliacs undergoing various minor dental procedures. The pertinent literature was reviewed and all evidence collected from various websites (Medline, Pubmed, Pakmedinet, Google searching tool) and textbooks of Haematology. Several studies have been conducted focused on adopting simpler protocols to stop bleeding in such individuals, which produce reliable results and thus limit the duration of their Hospital stay. For this purpose, it was suggested to administer different adjuvant therapies. Some of these suggested different combinations of systemic treatment and local hemostatic measures including intermittent tranexamic acid compression and concluded that it made dental extractions in such patients possible on an outpatient basis with a cost reduction and minor discomfort for them. This is a review article.
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