Epsilon-Aminocaproic Acid Therapy for Dental Extractions in Haemophilia and Christmas Disease: A Double Blind Controlled Trial

Summary. The results are reported of a pilot study and two separate double blind controlled trials of the effectiveness of epsilon-aminocaproic acid (EACA) in dental extractions in patients with haemophilia and Christmas disease. In the major trial 31 patients were studied; 23 at Oxford and eight at Cardiff. All patients received either EACA (6 g four times daily for 10 days at Oxford or for 7 days at Cardiff) or a placebo, in conjunction with a single preoperative dose of therapeutic materials expected to raise the plasma factor-VIII or factor-IX level to 50%. Post-operative therapeutic materials were withheld unless intraoral bleeding occurred. Despite the fact that plasma factor-VIII or factor-IX levels were, on average, lower, the number of teeth extracted larger, the amount of therapeutic concentrates less and the postinfusion plasma factor-VIII or factor-IX levels lower in the EACA group at Oxford, the incidence of postoperative intraoral bleeding was lower and the requirements for postoperative therapeutic materials less in the group treated with EACA. Side-effects were not a major problem. The number of patients studied at Cardiff was too few for statistical analysis but the results were similar to those at Oxford. The total conservation of therapeutic materials at Oxford in comparison to the amount utilized before EACA was used is estimated on the basis of these results to be approximately 12 000 factor-VIII or factor-IX units/patient, or approximately 190 units/kg/patient, equivalent, for each patient, to the amount derived from approximately 120 blood donations. These results show that EACA in conjunction with preoperative therapeutic concentrates sufficient to raise the plasma factor-VIII or factor-IX level to 50% can be useful for all patients with haemophilia and Christmas disease undergoing tooth extraction. In some patients EACA therapy is contraindicated and for these patients adequate cover with therapeutic materials must be provided during the postoperative period.