How are oral bleeding episodes managed in patients with hemophilia A?

Updated: Jan 14, 2019
  • Author: Douglass A Drelich, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Oral bleeding from the frenulum and bleeding after tooth extractions are not uncommon. Bleeding is aggravated by the increased fibrinolytic activity of saliva. If not treated appropriately, dental bleeding can persist and expand to sublingual, pharyngeal, facial, or dissecting neck hematomas or other serious bleeding.

Combine adequate replacement therapy with an antifibrinolytic agent (epsilon-aminocaproic acid [EACA]) to neutralize the fibrinolytic activity in the oral cavity. Topical agents such as fibrin sealant, bovine thrombin, and human recombinant thrombin can also be used. [31]

Hematoma in the pharynx or epiglottic regions frequently results in partial or complete airway obstruction; therefore, it should be treated with aggressive infusion therapy. Such bleeding may be precipitated by local infection or surgery.

Dental extractions or mucosal procedures can be handled with a single preprocedure dose of FVIII, to achieve a peak level of approximately 30%, along with a single 20 mg/kg dose of EACA. [32] Routine practice is to continue antifibrinolytic therapy in an outpatient setting for several days after the dental extraction, with a gradual tapering of the dosage over 5-7 days.


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