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

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.