Abstract：
BACKGROUND: The objectives were to describe the peri-operative management of people with inherited bleeding disorders in oral surgery and to investigate the association between type of surgery and risk of developing bleeding complications.
METHODS: This retrospective observational study included patients with haemophilia A or B, von Willebrand disease, Glanzmann thrombasthenia or isolated coagulation factor deficiency such as afibrinogenemia who underwent osseous (third molar extraction, ortho-surgical traction, dental implant placement) or nonosseous oral surgery between 2014 and 2021 at Bordeaux University Hospital (France). Patients and oral surgery characteristics were retrieved from medical records. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.
RESULTS: Of the 83 patients included, general anaesthesia was performed in 16%. Twelve had a bleeding complication (14.5%) including six after osseous surgery. The most serious complication was the appearance of anti-FVIII inhibitor in a patient with moderate haemophilia A. All bleeding complications were managed by a local treatment and factor injections where indicated. No association was observed between type of surgery (osseous vs. nonosseous) and risk of bleeding complications after controlling for sex, age, disease type and severity, multiple extractions, type of anaesthesia and use of fibrin glue (OR: 3.21, 95% CI: .69-14.88).
CONCLUSIONS: In this study, we have observed that bleeding complications after oral surgery in people with inherited bleeding disorders were moderately frequent and easily managed. However, in this study, we observed a serious complication highlighting the necessity of a thorough benefit-risk balance evaluation during the preoperative planning of the surgical and medical protocol.
METHODS: This retrospective observational study included patients with haemophilia A or B, von Willebrand disease, Glanzmann thrombasthenia or isolated coagulation factor deficiency such as afibrinogenemia who underwent osseous (third molar extraction, ortho-surgical traction, dental implant placement) or nonosseous oral surgery between 2014 and 2021 at Bordeaux University Hospital (France). Patients and oral surgery characteristics were retrieved from medical records. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.
RESULTS: Of the 83 patients included, general anaesthesia was performed in 16%. Twelve had a bleeding complication (14.5%) including six after osseous surgery. The most serious complication was the appearance of anti-FVIII inhibitor in a patient with moderate haemophilia A. All bleeding complications were managed by a local treatment and factor injections where indicated. No association was observed between type of surgery (osseous vs. nonosseous) and risk of bleeding complications after controlling for sex, age, disease type and severity, multiple extractions, type of anaesthesia and use of fibrin glue (OR: 3.21, 95% CI: .69-14.88).
CONCLUSIONS: In this study, we have observed that bleeding complications after oral surgery in people with inherited bleeding disorders were moderately frequent and easily managed. However, in this study, we observed a serious complication highlighting the necessity of a thorough benefit-risk balance evaluation during the preoperative planning of the surgical and medical protocol.
摘要：
背景：目的是描述口腔外科遗传性出血性疾病患者的围手术期管理，并研究手术类型与发生出血并发症风险之间的关系。
方法：这项回顾性观察研究包括A型或B型血友病患者，vonWillebrand病,Glanzmann血栓性或孤立的凝血因子缺乏，例如接受骨性（第三磨牙拔除，骨科牵引,牙科植入物的放置）或2014年至2021年在波尔多大学医院（法国）进行的非骨口腔手术。从病历中检索患者和口腔手术特征。使用逻辑回归估计赔率（OR）和95％置信区间（CI）。
结果：在83例患者中，16％的人进行了全身麻醉。12例发生出血并发症（14.5％），包括6例骨手术后。最严重的并发症是在患有中度血友病A的患者中出现抗FVIII抑制剂。所有出血并发症均通过局部治疗和指定的因子注射来管理。没有观察到手术类型之间的关联(骨与非骨）和控制性行为后出血并发症的风险，年龄,疾病类型和严重程度，多次提取,麻醉类型和使用纤维蛋白胶(OR:3.21,95%CI:.69-14.88)。
结论：在这项研究中，我们观察到,遗传性出血性疾病患者口腔手术后出血并发症的发生率中等,且易于处理.然而,在这项研究中，我们观察到一个严重的并发症,突出了在手术和医疗方案的术前计划过程中进行全面的获益-风险平衡评估的必要性.
方法：这项回顾性观察研究包括A型或B型血友病患者，vonWillebrand病,Glanzmann血栓性或孤立的凝血因子缺乏，例如接受骨性（第三磨牙拔除，骨科牵引,牙科植入物的放置）或2014年至2021年在波尔多大学医院（法国）进行的非骨口腔手术。从病历中检索患者和口腔手术特征。使用逻辑回归估计赔率（OR）和95％置信区间（CI）。
结果：在83例患者中，16％的人进行了全身麻醉。12例发生出血并发症（14.5％），包括6例骨手术后。最严重的并发症是在患有中度血友病A的患者中出现抗FVIII抑制剂。所有出血并发症均通过局部治疗和指定的因子注射来管理。没有观察到手术类型之间的关联(骨与非骨）和控制性行为后出血并发症的风险，年龄,疾病类型和严重程度，多次提取,麻醉类型和使用纤维蛋白胶(OR:3.21,95%CI:.69-14.88)。
结论：在这项研究中，我们观察到,遗传性出血性疾病患者口腔手术后出血并发症的发生率中等,且易于处理.然而,在这项研究中，我们观察到一个严重的并发症,突出了在手术和医疗方案的术前计划过程中进行全面的获益-风险平衡评估的必要性.
