Tooth extraction under emicizumab administration in a patient with severe hemophilia A with inhibitor

Abstract

　Bypass therapy has been the main hemostatic treatment for patients with hemophilia A with inhibitor. Emicizumab, approved in 2018, is rapidly becoming widespread due to its long half-life, low frequency of administration, convenience of subcutaneous route of administration, and high efficacy in preventing bleeding. We performed perioperative management of a 71-year-old man with severe hemophilia A with inhibitor who underwent multiple tooth extractions. Before using emicizumab, we infused a bypassing agent for several days, and it took 8-15 days to stop the bleeding. After using emicizumab, the number of additional infusions was reduced and the hemostasis period was shortened to 2-6 days. The administration of emicizumab was thought to have reduced the likelihood of post-extraction bleeding.