Brochures on coagulation disorders are also available for other major medical disciplines Relevant links to more information on von Willebrand disease and other Easy bruising with indurations coagulation disorders www.wfh.org www.nhlbi.nih.gov www.ehaweb.org www.ehc.eu www.esh.org www.hemophilia.ca www.hematology.org www.intreavws.com Frequent or prolonged www.allaboutbleeding.com nosebleeds Address of local haemophilia center: 5 signs Heavy menstrual periods Prolonged bleeding after injury, childbirth and surgery We would like to thank the international faculty for essential support: of bleeding information about coagulation disorders Dr. Andra James (MD) Debra Pollard (RN) Dr. Pieter Kamphuisen (MD) Dr. Kai Leimbach (odont.) dentists Dr. Johannes Rischewski (MD) Alexandra Eichert-Naumann Prolonged bleeding / mucous Dr. Elvira Grandone (MD) Dr. Hubert K. Hartl (MD)† membrane bleeding during dental work « These signs may indicate a coagulation disorder. To investigate further, please turn the page and use the questionnaire. Literature Plug I, et al. Bleeding in carriers of hemophilia. Blood 2006; 108: 52–56  Gupta A, et al. Bleeding disorders of importance in dental care and  related patient management. J Can Dental Assoc 2007; 73: 77–83 » Bleeding history Coagulation disorders in Treatment of patients with For further investigation, please ask these questions: dentistry coagulation disorders Medication and treatment pproximately 1% of the general population have a A Dental management Are you currently taking or have you recently received A - ntithrombotic medication: aspirin, heparin, clopidogrel, 5 minutes mutation in the von Willebrand factor gene oth the severity of the coagulation disorder and the B ticlopidine, vitamin-K antagonists (e.g. Marcumar, Warfarin)? emale carriers of haemophilia A & B have an F extent of dental intervention must be considered - Non steroidal anti inflammatory drugs: diclofenac, ibuprofen? A - ntibiotic medication: penicillin, tetracycline, sulfonamides, increased risk of bleeding after trauma and medical fluoroquinolones (e.g. Ciprofloxacin)? S urgical location is important with regard to  interventions O - ther drugs interacting with the coagulation system: - postoperative access to bleeding sites valproic acid, megadoses of vitamin E? ental procedures such as extractions and periodontal D 5 signs p - otential airway obstruction following haematoma to be safer Have you ever had anaemia that required treatment, surgery may be associated with postoperative bleeding formation or have you received a blood transfusion? Coagulation xcessive bleeding complicates suturing and may delay E In patients with untreated coagulation disorders Have you ever had a spontaneous nosebleed that either healing persisted for 10 mins or required medical attention? M inor procedures can cause prolonged bleeding, Have you ever experienced prolonged bleeding (duration of 15 mins, or spontaneous recurrence within 7 days) from minor It would be prudent to spend 5 minutes on ‘5 signs’ in any which can delay healing and may prevent completion wounds? of the following situations – either of these could indicate of the procedure, e.g. suturing Women only: Have you ever had heavy menses where you needed to change a pad, or a tampon, more than hourly? a coagulation disorder naesthetic injections are contraindicated due to risk A Have you ever experienced heavy, prolonged or recurrent bleeding after minor or major surgical procedures, such as B leeding for hours after a tooth extraction of haematoma dental extractions or tonsillectomy? Family History M ucous membrane bleeding during procedures R isk of excessive bleeding after extraction or periodon- Can you recall any coagulation disorders among family members tal surgery; endodontic therapy preferred to extraction (these must be blood relatives)? Do any members of your family (blood relatives) regularly adly fitting dentures or appliances can cause B experience any of the ‘5 signs of bleeding’? inflammation or ecchymosis If an answer concerning coagulation or family history is positive, consider referring the patient to a haematologist Before starting dental surgery, ask the patient about If you suspect a coagulation disorder, please determine symptoms of potential coagulation disorders. It only takes the patient’s ‘bleeding history’ 5 minutes – better safe than sorry!