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Peer-reviewedCC BYResearch and Practice in Thrombosis and Haemostasis

Factors associated with postextraction bleeding in patients with hemophilia: a multicenter retrospective cohort study

  • Kazumi Atarashi1
  • Hiroshi Nakamura1
  • Kotaro Kaneko2
  • Mirai Higaki3
  • Kuniko Mizuta4
  • Kotaro Sato5
  • Takahiro Yagyuu1
5 affiliations
  1. 1Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
  2. 2Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, Japan
  3. 3Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  4. 4Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
  5. 5Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract

Background: Postextraction bleeding, a form of postoperative hemorrhage, remains challenging in hemophilia, yet multicenter evidence linking bleeding to extraction technique and local hemostatic measures is limited. Objectives: This study aimed to determine postextraction bleeding incidence and identify associated factors at procedure and tooth levels. Methods: This retrospective multicenter cohort included patients with hemophilia A or B undergoing tooth extraction at 4 hemophilia care centers in Japan (January 2013 to March 2023). Postextraction bleeding was defined as bleeding not controlled by gauze compression requiring additional intervention within 14 days. Multivariable logistic regression analysis was performed. Results: The cohort included 198 patients (hemophilia A, 161; hemophilia B, 37), 271 procedures, and 512 extracted teeth. Bleeding occurred in 33 procedures (12.2%) and 38 teeth (7.4%); first bleeding occurred at a mean of postoperative day 5.3 (median 6). At the procedure level, extraction of ≥4 teeth were associated with higher bleeding incidence (adjusted odds ratio [OR] 2.60, 95% CI 1.02-6.65). Tranexamic acid use was associated with a lower incidence at both the procedure level (adjusted OR 0.43, 95% CI 0.20-0.93) and tooth level (adjusted OR 0.38, 95% CI 0.18-0.78), and primary wound closure was associated with bleeding (adjusted OR 11.2, 95% CI 1.42-89.3). No thrombotic events were documented. Conclusion: Delayed postextraction bleeding remains relatively common in hemophilia despite specialist care. Multiple extractions and nonuse of tranexamic acid was associated with postextraction bleeding. Findings require cautious interpretation because of retrospective design, confounding by indication, and limited bleeding events.

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Cite

BibTeXRIS
BibTeX
@article{atarashi2026factors,
  title = {{Factors associated with postextraction bleeding in patients with hemophilia: a multicenter retrospective cohort study}},
  author = {Kazumi Atarashi and Hiroshi Nakamura and Kotaro Kaneko and Mirai Higaki and Kuniko Mizuta and Kotaro Sato and Takahiro Yagyuu},
  journal = {Research and Practice in Thrombosis and Haemostasis},
  year = {2026},
  month = aug,
  doi = {10.1016/j.rpth.2026.106903},
  url = {https://doi.org/10.1016/j.rpth.2026.106903},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Factors associated with postextraction bleeding in patients with hemophilia: a multicenter retrospective cohort study
AU  - Kazumi Atarashi
AU  - Hiroshi Nakamura
AU  - Kotaro Kaneko
AU  - Mirai Higaki
AU  - Kuniko Mizuta
AU  - Kotaro Sato
AU  - Takahiro Yagyuu
PY  - 2026
DA  - 2026/08/01
JO  - Research and Practice in Thrombosis and Haemostasis
DO  - 10.1016/j.rpth.2026.106903
UR  - https://doi.org/10.1016/j.rpth.2026.106903
AB  - Background: Postextraction bleeding, a form of postoperative hemorrhage, remains challenging in hemophilia, yet multicenter evidence linking bleeding to extraction technique and local hemostatic measures is limited. Objectives: This study aimed to determine postextraction bleeding incidence and identify associated factors at procedure and tooth levels. Methods: This retrospective multicenter cohort included patients with hemophilia A or B undergoing tooth extraction at 4 hemophilia care centers in Japan (January 2013 to March 2023). Postextraction bleeding was defined as bleeding not controlled by gauze compression requiring additional intervention within 14 days. Multivariable logistic regression analysis was performed. Results: The cohort included 198 patients (hemophilia A, 161; hemophilia B, 37), 271 procedures, and 512 extracted teeth. Bleeding occurred in 33 procedures (12.2%) and 38 teeth (7.4%); first bleeding occurred at a mean of postoperative day 5.3 (median 6). At the procedure level, extraction of ≥4 teeth were associated with higher bleeding incidence (adjusted odds ratio [OR] 2.60, 95% CI 1.02-6.65). Tranexamic acid use was associated with a lower incidence at both the procedure level (adjusted OR 0.43, 95% CI 0.20-0.93) and tooth level (adjusted OR 0.38, 95% CI 0.18-0.78), and primary wound closure was associated with bleeding (adjusted OR 11.2, 95% CI 1.42-89.3). No thrombotic events were documented. Conclusion: Delayed postextraction bleeding remains relatively common in hemophilia despite specialist care. Multiple extractions and nonuse of tranexamic acid was associated with postextraction bleeding. Findings require cautious interpretation because of retrospective design, confounding by indication, and limited bleeding events.
SN  - 2475-0379
ER  -