<abstract xmlns="http://www.w3.org/1999/xhtml"><p> People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.</p></abstract>

People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.

Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

The Journal of Haemophilia Practice

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental...

PROCEDURE	INTERVIEWED	EXCLUDED	NON-RESPONDER	TOTAL
Extraction	30	2	8	40
Hygienist	6	4	4	14
Oral surgery	3	0	0	3
All	39	6	12	57

VARIABLES	TXA <3 DAYS	TXA 3 DAYS	TXA >3 DAYS	TOTAL
Age (mean)	50 years	50 years	75 years	51 years
Extraction	10	16	4	30
Hygienist	6	0	0	6
Oral surgery	2	1	0	3

All patients	• TXA to be commenced two hours before dental procedure• TXA to be taken every six hours for three days post-procedure
Moderate or severe IBD	• TXA mouthwash solution – to be swished around the mouth for two minutes, then swallowed
Mild IBD	• TXA tablets, OR • If postoperative bleeding is noted, TXA tablets crushed, mixed with water and used as a mouth rinse for two minutes, then swallowed

FORM OF TXA PRESCRIBED	NO. OF PATIENTS	COST (£)	TOTAL (£)
Tablets only	45	4.22	189.90
Mouthwash only	2	145.00	290.00
Tablets and mouthwash	3	149.22	447.66
Total	50		927.56

Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

Article Category: Clinical Research

Published Online: Jun 28, 2018

Page range: 42 - 49

DOI: https://doi.org/10.17225/jhp00110

Keywords
Antifibrinolytics, Bleeding disorders, Dental procedures, Haemophilia, Tranexamic acid, Service evaluation

© 2018 Allison Greig, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Figure 2

Figure 3

Figure 4

Summary of patients referred for dental procedures during the study period

Treatment adherence in relation to age and procedure

Amended TXA prescribing guidelines for patients with IBDs undergoing dental procedures

Costs of TXA prescribed during the study period

Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

Article Category: Clinical Research

Published Online: Jun 28, 2018

Page range: 42 - 49

DOI: https://doi.org/10.17225/jhp00110

KeywordsAntifibrinolytics, Bleeding disorders, Dental procedures, Haemophilia, Tranexamic acid, Service evaluation

© 2018 Allison Greig, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Figure 2

Figure 3

Figure 4

Summary of patients referred for dental procedures during the study period

Treatment adherence in relation to age and procedure

Amended TXA prescribing guidelines for patients with IBDs undergoing dental procedures

Costs of TXA prescribed during the study period

Keywords
Antifibrinolytics, Bleeding disorders, Dental procedures, Haemophilia, Tranexamic acid, Service evaluation