Objectives

This systematic review aims to analyze the systemic administration of antifibrinolytics (tranexamic acid and aminocaproic acid) to prevent postoperative bleeding in patients with hemophilia.

Methods

This systematic review was conducted adhering to PRISMA guidelines. Only randomized controlled trials that assessed human subjects of any age or gender with any severity of hemophilia undergoing dental extractions, and systemically administered antifibrinolytic therapy compared to placebo were included. Post-operative bleeding episodes and adverse events were presented. PubMed, Cochrane, Embase, CINAHL, Web of Science, and Scopus were searched through April 15, 2022. The risk ratio (RR) and odds ratio (OR) applying 95% confidence intervals (CI) were computed using RevMan 5.4.1 (Cochrane).

Results

Two randomized, placebo-controlled trials pooling in a total of 59 patients were pooled in this analysis. Among patients administered antifibrinolytic therapy, 84% reduced risk of post-operative bleeding was reported (RR = 0.16, 95% CI = 0.05–0.47, P = 0.0009). The chances of post-operative bleeding were reduced by 95% among the antifibrotics group (OR = 0.05, 95% CI = 0.01–0.22, P < 0.0001).

Conclusion

This review finds favorable outcomes for the routine use of antifibrinolytic therapy for dental extractions in hemophiliacs. Further trials are required to rationalize existing evidence.

中文翻译：

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抗纤溶治疗对预防拔牙的血友病患者出血有效吗？系统评价和荟萃分析

目标

本系统评价旨在分析抗纤溶药物（氨甲环酸和氨基己酸）的全身给药以预防血友病患者术后出血。

方法

该系统评价是按照 PRISMA 指南进行的。仅纳入随机对照试验，评估任何年龄或性别、任何严重程度的血友病接受拔牙的人类受试者，以及与安慰剂相比全身给予抗纤溶治疗。介绍了术后出血事件和不良事件。PubMed、Cochrane、Embase、CINAHL、Web of Science 和 Scopus 检索到 2022 年 4 月 15 日。使用 RevMan 5.4.1 计算应用 95% 置信区间 (CI) 的风险比 (RR) 和优势比 (OR) (科克伦）。

结果

在这项分析中汇集了两项随机、安慰剂对照试验，共纳入 59 名患者。据报道，在接受抗纤溶治疗的患者中，术后出血风险降低了 84%（RR = 0.16，95% CI = 0.05-0.47，P = 0.0009）。抗纤维化组术后出血的几率降低了 95%（OR = 0.05, 95% CI = 0.01-0.22, P < 0.0001）。

结论

本综述发现血友病患者常规使用抗纤溶治疗进行拔牙的结果良好。需要进一步的试验来合理化现有的证据。