Protocolo clínico para el manejo endodóntico en pacientes con hemofilia basado en la evidencia

Abstract

Hemophilia is a hereditary bleeding disorder characterized by a deficiency of coagulation factors VIII or IX, increasing the risk of bleeding during invasive dental procedures. The absence of specific and updated guidelines in endodontics may compromise the safe management of these patients. Objective. To determine the essential clinical, pharmacological, and technical criteria for the development of a safe and effective protocol for the endodontic management of patients with hemophilia and other coagulation disorders. Materials and methods. A literature review was conducted using PubMed/MEDLINE, Scopus, Embase, Cochrane Library, and Google Scholar databases, including studies published in English and Spanish between 1995 and 2025. Results. Thirty-five articles met the inclusion criteria. The evidence highlighted the importance of interdisciplinary collaboration between the endodontist and hematologist, coagulation control, antifibrinolytic therapy, appropriate anesthetic techniques, and rubber dam isolation to minimize bleeding risk. Conclusion. Endodontic treatment represents a conservative and safe alternative to more invasive surgical procedures. The implementation of evidence-based clinical protocols contributes to safer dental care, reduces hemorrhagic complications, and improves treatment outcomes in patients with hemophilia.