Effect of local antifibrinolytic treatment with tranexamic acid in hemophiliacs undergoing oral surgery.

The objectives of the present clinical investigation were to examine the effects in hemophiliacs of local antifibrinolytic treatment with tranexamic acid on the incidence of postoperative bleeding after oral surgery and on the amount of replacement therapy needed to control bleeding. The study compared three groups of patients. The patients in group A received high doses of factor concentrate and systemic antifibrinolytic treatment with tranexamic acid. In group B local antifibrinolytic treatment with tranexamic acid was added to the treatment received by group A. Group C received replacement therapy to raise factor levels to approximately 10% of the normal value perioperatively, combined with systemic and local antifibrinolytic treatment (mouth rinse) with tranexamic acid. The study demonstrated that local antifibrinolytic therapy with tranexamic acid as a supplement to the currently used systemic therapy significantly reduces the incidence of postoperative bleeding. The results of the study further suggest that replacement therapy can be reduced during oral surgery in the hemophilic patient provided that local and systemic inhibition of fibrinolysis is instituted.