The choice of appropriate systemic therapy for dental procedures should be made in consultation with the patient’s hematologist. Decisions regarding the need for, and type of, coagulation factor replacement will depend on the specific hemostatic diagnosis, the severity of the bleeding diathesis and the type of dental procedure (major or minor). Table 7 outlines systemic replacement therapy options for vWD and hemophilia.37 Some patients may require further laboratory testing before dental surgery, such as a trial of desmopressin to confirm adequate response, or screening for inhibitors. The choice of factor replacement for individuals with rare coagulation disorders should be made in consultation with a hematologist familiar with the replacement products and local availability (as some are unlicensed).
Appropriate prophylaxis for platelet disorders will depend on both the specific defect and the nature of the planned dental surgery (Table 8). Mild thrombocytopenia or mild functional disorders may require no specific systemic therapy other than the use of local hemostatic measures and antifibrinolytic agents. More severe disorders will require measures that transiently raise the platelet count or improve function. Choice of the appropriate prophylaxis should be made in consultation with the patient’s physician.