ABSTRACT
von Willebrand disease is a hereditary disease associated with a tendency to bleed and it is important to reduce the possibility of bleeding in a procedure. This case describes the use of a hemostatic factor, Factor VIII concentrate (Confact F®), during a dental procedure involving teeth extraction and implant placement.
Keywords: , von Willebrand disease, a hemostatic factor, Factor VIII concentrate (Confact F®)
Introduction
Eric von Willebrand first reported Von Willebrand disease (VWD) in 1926.1 It is a congenital condition that results in an excessive tendency to bleed owing to the quantitative and qualitative abnormalities of von Willebrand factor (VWF).2 In the perioperative management of VWD patients, it is necessary to reduce bleeding by preoperatively replenishing coagulation factors and stabilizing hemodynamics during anesthesia. Herein, we report our experience with a patient with VWD. We performed safe perioperative hemostatic management under intravenous sedation by supplementing with heat-treated factor VIII concentrate (Confact F®) before extracting the teeth and placing implants. Written consent was obtained from the patient for this report.
Case Report
The patient is a 57-year-old man (height, 173.5 cm; weight, 61.7 kg), and the
remaining teeth in his lower jaw were 1, 2, and 3 on the right side and 1, 4, and 5 on the left side. The patient had chronic apical periodontitis and severe periodontal disease. There was teeth movement, and it was difficult to preserve them. We planned to extract these teeth and place six implants (Figure 1).
A physician had suspected the presence of VWD when the patient was aged 21 years, but no detailed testing or treatment was performed. The family history was not relevant and the patient was on no current medications.
In terms of preoperative chest findings, the chest X-ray was normal (Figure 2) with a normal cardiothoracic ratio of 42%, and there were no particular issues. Blood test results are shown in Table 1. The platelet count, a hemostatic factor, was 360,000/µl, the activated partial thromboplastin time was 35.4 seconds, and the prothrombin time 11.7 seconds; all were within normal limits. However, coagulation factor VIII was 49%, and VWF activity was 24%, indicating that the coagulation factor was lower than normal. Based on detailed testing carried out by our hospital’s hematology department, the patient was diagnosed with Type 1 VWD, in which there is a quantitative decrease in the VWF.
There was nothing of particular note in terms of family history. Implants in the upper jaw had already been placed at a different hospital, and there had been some difficulty stopping the bleeding when the teeth were extracted. In this case, after consulting with the hematology department, we decided that surgery would be possible by transfusing heat-treated factor VIII concentrate (Confact F®), which contains VWF. This transfusion was done to prevent abnormal bleeding during surgery. Furthermore, considering the risk of bleeding due to fluctuations in hemodynamics, with the patient’s consent, we planned to carry out tooth extraction and implant placement under local anesthesia with intravenous sedation.