Retrospective evaluation of multidisciplinary perioperative hemostatic management in oral surgery for patients with hemophilia

Objectives: This study evaluated the clinical efficacy and safety of an individualized, multidisciplinary perioperative hemostatic management coordinated by the Department of Pediatrics for oral and maxillofacial surgery in hemophilia patients at a single tertiary medical center. Materials and Methods: We retrospectively reviewed 13 hemophilia patients (hemophilia A: 11; hemophilia B: 2) who underwent oral surgery under individualized multidisciplinary perioperative hemostatic management at Busan Paik Hospital, Inje University, between 2021 and 2025, including preoperative hospital admission, individualized clotting factor replacement, intravenous tranexamic acid, and preoperative confirmation of activated partial thromboplastin time (aPTT). The primary outcome was intraoperative and postoperative hemorrhagic complications. Results: A total of 21 surgical cases (including 37 tooth extractions) were analyzed. Disease severity was severe in 7 patients (58.3%), moderate in 2 (16.7%), and mild in 3 (25.0%); one patient with undocumented factor activity was excluded. One inhibitor-positive patient was managed with activated prothrombin complex concentrate (FEIBA). By World Federation of Hemophilia classification, 16 cases (76.2%) were major and 5 (23.8%) minor procedures. The primary hemostasis success rate was 95.2% (20/21 cases), and the overall complication rate was 14.3% (3/21 cases): one readmission for delayed secondary hemorrhage (mild hemophilia B), one odontogenic cellulitis, and one minor intraoperative oozing in the inhibitor-positive patient. Mean hospital stay was 5.5±1.5 days (inpatients only, n=16/21; range 4-9). No uncontrolled major hemorrhage or mortality occurred. Conclusion: In this small single-center retrospective series without a control group, individualized multidisciplinary perioperative hemostatic management was associated with favorable outcomes (success rate 95.2%; complication rate 14.3%). These descriptive findings suggest that multidisciplinary collaboration, perioperative confirmation of inhibitor status, and thorough discharge education may be important components of perioperative care in hemophilia patients, though they should not be interpreted as demonstrating the causal superiority of any single care model, pending prospective, controlled confirmation.