Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

Abstract

Background Patients using antiplatelet drugs following infarctions, acute coronary syndrome or stroke pose a significant clinical problem if it is necessary to perform surgery, including dental surgery, since they are at risk of prolonged or secondary post-extraction bleeding. Discontinuation of this therapy is associated with a high risk of serious thromboembolic complications. The purpose of this study was to assess the effectiveness of TachoSil fibrin-collagen patches in stopping and preventing of secondary post-extraction bleeding in patients undergoing chronic antiplatelet therapy. Methods The study was conducted through retrospective examination of the medical records of 153 patients using chronic antiplatelet therapy and those qualified for tooth extraction. The largest group comprised 74 patients using aspirin and clopidogrel as dual platelet antiaggregation therapy; in this group 75 tooth extractions were carried out. In all of the patients TachoSil fibrin-collagen patches and stiches were applied to the wounds resulting from tooth removal. Results Following tooth extraction, primary bleeding was stopped in all the patients and their wounds closed via coagulation within 20–30 min. In eight cases, accounting for 4.9% of the patients, secondary bleeding occurred and was successfully stopped only by applying a pressure dressing soaked in tranexamic acid. Secondary bleeding occurred in three patients on the second day and in five patients on the third day following tooth removal. Conclusion Topical application of TachoSil patches following tooth removal in patients using single or dual antiplatelet therapy effectively stopped bleeding and prevented secondary bleeding after tooth extraction.

Tranexamic acid: Beyond antifibrinolysis

“…20 This appears to be true in patients who are anticoagulated at the time of their dental procedure. 21 Interestingly, TXA appears to control bleeding in patients on anticoagulants. 21…”

“…Evidence exists to support the use of topical TXA in the periprocedural period to prevent blood loss in patients undergoing dental surgery 20 . This appears to be true in patients who are anticoagulated at the time of their dental procedure 21 . Interestingly, TXA appears to control bleeding in patients on anticoagulants 21 …”

Perioperative Management of Dental Surgery Patients Chronically Taking Antithrombotic Medications

“…After the procedure, a saturating dose of the discontinued drug should be given within 24–72 h. In emergency situations, it is best to perform the procedure in a hospital with an interventional cardiology unit ( Table 2 ). If stent thrombosis recurs, a coronary intervention will be available [ 1 , 2 , 3 , 6 , 8 , 22 , 23 , 24 , 25 ].…”

“…When performing surgical procedures in patients continuously taking antithrombotic therapy, it is also important to remember to use appropriate techniques and procedures designed specifically to minimize their invasiveness. Particular attention should be given to the use of tools and devices that reduce the severity of perioperative bleeding as well as to achieving and maintaining normal homeostasis [ 1 , 22 , 25 , 26 , 27 ].…”

The Potential of Shell Extract as a Hemostasis and Wound Healing Agent: A Literature Review

“…Monitoring bleeding is crucial following tooth extraction, especially in individuals taking oral anticoagulants for cerebrovascular or cardiovascular conditions (4). It is estimated that approximately 5% of patients on antiplatelet therapy may encounter clinical issues if subjected to tooth extraction (5). Achieving hemostatic balance and controlling bleeding after tooth extraction can pose challenges in individuals taking antiplatelets due to impaired blood clotting, and uncontrolled bleeding may have severe consequences, particularly in traumatic injuries, potentially leading to fatality.…”