Dental Management of Persons With Haemophilia Receiving Emicizumab Prophylaxis

The use of emicizumab prophylaxis among persons with haemophilia A (PwHA), both with and without inhibitors, has been increasing significantly in recent years. Nevertheless, clear recommendations remain lacking regarding the necessity and extent of perioperative adjunctive systemic haemostatic therapy for surgical procedures. Given the high frequency of dental interventions, minor oral surgical procedures, are of particular clinical relevance for these persons. This paper provides a review of the literature along with a retrospective analysis of a case series involving 10 PwHA who underwent invasive dental procedures across three centres. In cases involving permanent tooth extraction a single preoperative dose of rFVIII (for PwHA without inhibitors) or rFVIIa (for those with inhibitors) were used. The analysis indicated that extraction of primary teeth in children receiving emicizumab prophylaxis can be successfully performed without the concomitant use of systemic haemostatic agents. Only one postoperative bleeding event was observed, following a periodontal procedure, suggesting that type of procedure may pose a greater challenge in achieving adequate hemostasis due to larger bleeding area and limited possibility for the use of local haemostatic measures. A review of the literature showed that for minor oral surgical procedures, such as tooth extraction, either preoperative administration of haemostatic factor infusions or performing the procedure without factor use may be recommended. However, evidence-based data and recommendations regarding the safest management strategies remain insufficient. A multidisciplinary and individualized approach, incorporating assessment of the procedural bleeding risk, the patient's bleeding history, and strict use of local haemostatic measures remains essential.