Outpatient tooth extraction in a patient with von Willebrand disease managed with antifibrinolytic premedication: a case report

Abstract

Von Willebrand disease is the most common inherited bleeding disorder. It is caused by a quantitative or qualitative deficiency of von Willebrand factor, which promotes platelet adhesion and stabilizes factor VIII, thereby contributing to normal hemostasis. This report presents the case of a 7-year-old boy weighing 23 kg with a confirmed diagnosis of type 2A von Willebrand disease who required extraction of a supernumerary tooth before orthopedic and orthodontic treatment. Following an individualized hematologic assessment and review of the patient’s hematologic profile, the hematologist prescribed preoperative and postoperative tranexamic acid, supplemented by local hemostatic measures and analgesic therapy. The surgical procedure was performed atraumatically, with no immediate bleeding complications and favorable clinical healing at the 7-day follow-up. This case highlights the importance of preoperative planning, interdisciplinary communication, and meticulous local hemostasis. The observed outcome cannot be attributed to any single intervention, nor can this management approach be generalized to other patients with type 2A von Willebrand disease. The strategy described was based on an individualized recommendation by the hematology service.