EFFECT OF LOCAL ANTIFIBRINOLYTIC TREATMENT WITH TRANEXAMIC ACID IN HEMOPHILIACS UNDERGOING ORAL SURGERY
Main Article Content
Keywords
Tranexamic acid, hemophilia, oral surgery, bleeding, hemostatic management
Abstract
Background: Hemophilia is an inherited bleeding disorder that poses difficulties during surgical treatments because of the increased risk of bleeding. Tranexamic acid (TXA) prevents the breakdown of blood clots, has been suggested as a way to decrease bleeding during surgery in many medical contexts.
Objectives: To assess the efficacy and safety of locally administered TXA in minimizing bleeding and the need for systemic hemostatic medicines in individuals with hemophilia having oral surgery. Methods: This study utilized a cross-sectional design and included a total of 78 patients who were diagnosed with either Hemophilia A or B. The patients were between the ages of 18 and 65 and were undergoing procedures such as tooth extractions, dental implant installs and other minor oral surgeries. Patients were administered intravenous TXA before to the surgical procedure. Their bleeding was assessed using visual analog scale (VAS) and their hemoglobin levels were measured before and 24 hours after the surgery. Additionally, the requirement for supplementary hemostatic drugs was observed. Furthermore, adverse events were documented.
Results: The utilization of TXA effectively decreased postoperative bleeding, as indicated by lower VAS values and decreased reliance on extra systemic drugs (p<0.05). Post-surgery, there was a statistically significant fall in hemoglobin levels, but the decrease was small. Adverse events were infrequent and of low severity, with only 2.6% of individuals reporting allergic responses and 1.3% experiencing thromboembolic events.
Conclusion: Tranexamic acid is proven to be useful in lowering surgical bleeding in hemophiliacs who are undergoing oral surgery. Additionally, it has a positive safety profile. Its utilization is advisable as a component of standard care procedures to augment surgical outcomes in this population of patients at high risk.
References
2. Peisker A, Raschke GF, Schultze-Mosgau S. Management of dental extraction in patients with Haemophilia A and B: a report of 58 extractions. Med Oral Patol Oral Cir Bucal. 2014 Jan 1;19(1):e55-60. doi: 10.4317/medoral.19191.
3. Raikuna AFV, Prabhu N. Protocols for Oral Health Management of Paediatric Patients with Inherited Bleeding Disorders: A Narrative Review. Oral. 2023;3:462-476. doi: 10.3390/oral3040037.
4. Carless PA, Moxey AJ, Stokes BJ. Are antifibrinolytic drugs equivalent in reducing blood loss and transfusion in cardiac surgery? A meta-analysis of randomized head-to-head trials. BMC Cardiovasc Disord. 2005;5:19. doi: 10.1186/1471-2261-5-19.
5. Liu L, Rodman C, Worobetz NE. Topical biomaterials to prevent post-tonsillectomy hemorrhage. J Otolaryngol - Head Neck Surg. 2019;48:45. doi: 10.1186/s40463-019-0368-1.
6. McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012 Mar 26;72(5):585-617. doi: 10.2165/11209070-000000000-00000.
7. Lam T, Medcalf RL, Cloud GC, et al. Tranexamic acid for haemostasis and beyond: does dose matter? Thrombosis J. 2023;21:94. doi: 10.1186/s12959-023-00540-0.
8. Cai J, Ribkoff J, Olson S, et al. The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020 Feb;104(2):79-87. doi: 10.1111/ejh.13348.
9. Ockerman A, Vanassche T, Garip M. Tranexamic acid for the prevention and treatment of bleeding in surgery, trauma and bleeding disorders: a narrative review. Thrombosis J. 2021;19:54. doi: 10.1186/s12959-021-00303-9.
10. Sindet-Pedersen S, Stenbjerg S. Effect of local antifibrinolytic treatment with tranexamic acid in hemophiliacs undergoing oral surgery. J Oral Maxillofac Surg. 1986 Sep;44(9):703-7. doi: 10.1016/0278-2391(86)90039-x.
11. Levy JH, Koster A, Quinones QJ, et al. Antifibrinolytic Therapy and Perioperative Considerations. Anesthesiology. 2018 Mar;128(3):657-670. doi: 10.1097/ALN.0000000000001997.
12. Bryant-Smith AC, Lethaby A, Farquhar C, et al. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2018 Apr 15;4(4):CD000249. doi: 10.1002/14651858.CD000249.pub4.
13. Rossaint R, Afshari A, Bouillon B. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27:80. doi: 10.1186/s13054-023-04327-7.
14. Wu J, Zhou YQ, Deng JH, et al. Ideal intraarticular application dose of tranexamic acid in primary total knee arthroplasty: a prospective, randomized and controlled study. Ann Transl Med. 2020 Nov;8(21):1353. doi: 10.21037/atm-20-3064.
15. Pabinger I, Fries D, Schöchl H, et al. Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis. Wien Klin Wochenschr. 2017 May;129(9-10):303-316. doi: 10.1007/s00508-017-1194-y.
16. Farzanegan G, Ahmadpour F, Khoshmohabbat H, et al. The Effect of Topical Tranexamic Acid on Intraoperative Blood Loss in Patients Undergoing Posterior Lumbar Laminectomy and Discectomy: A Randomized, Double-Blind, Controlled Trial Study. Asian Spine J. 2022 Dec;16(6):857-864. doi: 10.31616/asj.2021.0285.
17. Mohammadi M, Nouri-Mahdavi K, Barzegar A. Effects of Tranexamic Acid on Bleeding and Hemoglobin Levels in Patients with Staghorn Calculi Undergoing Percutaneous Nephrolithotomy: Randomized Controlled Trial. Iran J Med Sci. 2019 Nov;44(6):457-464. doi: 10.30476/ijms.2019.44969.
18. Abu-Zaid A, Baradwan S, Badghish E, et al. Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials. Obstet Gynecol Sci. 2022 Sep;65(5):406-419. doi: 10.5468/ogs.22115.
19. Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016 Mar;60(3):289-334. doi: 10.1111/aas.12651.
20. Satkunasivam R, Klaassen Z, Ravi B, et al. Relation between surgeon age and postoperative outcomes: a population-based cohort study. CMAJ. 2020 Apr 14;192(15):E385-E392. doi: 10.1503/cmaj.190820.
21. Mehic D, Neubauer G, Janig F, et al. Risk factors for future bleeding in patients with mild bleeding disorders: longitudinal data from the Vienna Bleeding Biobank. J Thromb Haemost. 2023 Jul;21(7):1757-1768. doi: 10.1016/j.jtha.2023.03.006.
22. Soucie JM, Monahan PE, Kulkarni R, et al. The frequency of joint hemorrhages and procedures in nonsevere hemophilia A vs B. Blood Adv. 2018 Aug 28;2(16):2136-2144. doi: 10.1182/bloodadvances.2018020552.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Firdous Khan
Assistant Professor Plastic Surgery & Burns Unit, Ayub Medical Complex, Abbottabad -Pakistan
Inaas Rizwan Akhund
BDS, RDS, Isra University, Hyderabad - Pakistan
Amir Derick
Assistant Professor, Department of Oral Biology, Liaquat University of Medical and Health Sciences, Jamshoro - Pakistan
Syna Pervaiz Singha
Associate Professor, Department of Anatomy, Isra University, Hyderabad - Pakistan
Abroo Fatima Qazi
Associate Professor, Department of Physiology, Isra University, Hyderabad - Pakistan
Qudsia Anjam Qureshi
Assistant Professor Anesthesia, Rawalpindi Institute of Cardiology, Rawalpindi - Pakistan