抄録
Epinephrine, nicotic acid, vasopressin and other drugs affecting vascular motility are known to increase factor VIII plasma levels in human. Especially 1-deamino-8-D-arginine vasopressin (DDAVP), a synthetic analogue of vasopressin, is hemostatically effective in patients with mild hemophilia A and von Willebrand's disease. The effect of DDAVP on the oral bleeding management of these patients is under ivestigation in our clinic.
Lidocaine cartridge (2% lidocaine 1.8ml) which is used for local anesthesia on tooth extraction contains 22.5μg of epinephrine. The purpose of this study was to see if the factor VIII can be responsed to epinephrine contained in the lidocaine cartridge.
Prothrombin time (PT), activated partial thromboplastin time (APTT), factor VIII coagulability (F VIII: C) and factor VIII related antigen (F VIII R: Ag) were measured immediately before and 30 minutes, 1 hour and 2 hours after submucosal injection of 1.8ml lidocaine (22.5μg epinephrine) in 10 normal individuals and 3.6ml (45.0μg) in 5. Moreover, 4 patients with hemophilia A and 1 patient with von Willebrand's disease were observed prior to and 30 minutes after the injection of 1.8ml lidocaine (22.5μg epinephrine).
PT, APTT, FVIII: C and F VIII R: Ag showed no significant changes statistically 30 minutes, 1 hour and 2 hours after stimulation of epinephrine in normal subjects. In hemophiliacs and one von Willebrand's patient similar results were found.
It is suggested that the effect of epinephrine contained in the local anesthesic can be omitted in the study of DDAVP on the management of postextraction bleeding in patients with hemophilia A and von Willebrand's disease.
