Dental management of patients with haemophilia in the era of recombinant treatments: increased efficacy and decreased clinical risk

Abstract

Haemophilia is a hereditary X-linked recessive disorder caused by a deficiency of either clotting factor VIII (haemophilia A) or IX (haemophilia B). Conventional treatment is currently based on the use of either plasma derived or recombinant coagulation factors. This paper reports on the case of a patient with severe haemophilia who presented with mesial decay and interproximal tartar build-up, for which extraction and scaling to remove tartar deposits were indicated. Following extraction, the usual haemostasis techniques were applied, and postoperative prophylactic antihaemophilic treatment was indicated for 2 or 3 days. The patient presented with moderate bleeding for a few minutes immediately after the procedure. Administration of factor VIII before surgery as well as the patient's favourable pharmacokinetic response allowed for an optimal result. This treatment has afforded patients with haemophilia a better quality of life, and safe and efficient access to invasive surgical procedures.

Keywords: dentistry and oral medicine; haematology (incl blood transfusion); pharmacology and therapeutics.

Figure 1

Bayesian estimation of the patient’s pharmacokinetic parameters. The curve illustrates factor VIII activity over time following intravenous administration of factor VIII. The grey area represents the deviation (±20%) with respect to the general population; (- - -), pharmacokinetics in the general population; (♦), patient’s data; (---), Bayesian pharmacokinetic estimation.

Figure 2

Dose optimisation. Prediction of the patient’s factor VIII plasma levels. (A) Pre-procedure factor VIII administration. (B) Dental procedure. (C) Onset of recovery period. (D) Prophylactic treatment: 12 hours (D12) and 24 hours (D24). (·) Factor VIII plasma level (>90%) at the time of the procedure. Factor VIII remained between 40% and 140% (- - -) during the recovery period.