What are the recommended management strategies for a patient with mild Haemophilia A who is undergoing dental surgery?

For a patient with mild Haemophilia A undergoing dental surgery, management should focus on minimizing bleeding risk through careful preoperative assessment and perioperative haemostatic support. This includes consultation with a haematologist to evaluate factor VIII levels and consider prophylactic factor VIII replacement therapy if necessary to raise levels to a safe threshold prior to surgery. Local measures such as atraumatic surgical techniques, use of local haemostatic agents (e.g., tranexamic acid mouthwash), and meticulous suturing are recommended to control bleeding effectively during and after the procedure. Additionally, avoiding medications that increase bleeding risk, such as non-steroidal anti-inflammatory drugs, is advised.

Preoperative coagulation screening and planning are essential, with factor VIII activity assessment guiding the need for replacement therapy. For mild Haemophilia A, where baseline factor VIII levels are typically 5-40%, minor dental procedures may sometimes be managed with local haemostatic measures alone, but more invasive procedures generally require factor replacement to achieve near-normal levels temporarily. Postoperative monitoring for bleeding and prompt management of any haemorrhagic complications are critical.

These recommendations align with the integrative review by Kumar et al. (2025), which highlights the importance of individualized haemostatic management and local bleeding control strategies in dental care for haemophilia patients. The review emphasizes that prophylactic factor replacement combined with local measures significantly reduces bleeding complications in dental surgery for congenital haemophilia patients (Kumar et al., 2025).

While UK guidelines on anticoagulation and bleeding disorders do not provide detailed protocols specifically for haemophilia in dental surgery, principles from bleeding disorder management and perioperative care suggest multidisciplinary coordination, including haematology input, is essential to optimize outcomes ¹.