Local Tranexamic Acid for Preventing Hemorrhage in Anticoagulated Patients Undergoing Dental and Minor Oral Procedures: A Systematic Review and Meta-Analysis

Abstract

Dental procedures have posed challenges in managing anticoagulated patients due to early reports of oral hemorrhage. This study aims to evaluate the risks of postoperative bleeding with the local application of tranexamic acid. A systematic search was conducted until 31 March 2022, with keywords including tranexamic acid, oral hemorrhage, dental, and/or coagulation. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane Library. Statistical analysis was conducted using Review Manager 5.4. In total, 430 patients were pooled in with the local application of tranexamic acid using mouthwash, irrigation, and compression with a gauze/gauze pad. The mean age was 61.8 years in the intervention group and 58.7 in the control group. Only 4 patients in the intervened group out of the 210 discontinued the trial due to non-drug-related adverse events. The risk difference was computed as −0.07 (p = 0.05), meaning that patients administered with local antifibrinolytic therapy for postoperative bleeding reduction for dental procedures were at a 7% less risk of oral bleeding. Current evidence on managing anticoagulated patients undergoing dental or oral procedures remains unclear. The present study presents favorable outcomes of postoperative bleeding with local tranexamic acid used in the postoperative period.

The Effectiveness and Safety of Autologous Platelet Concentrates as Hemostatic Agents after Tooth Extraction in Patients on Anticoagulant Therapy: A Systematic Review of Randomized, Controlled Trials

“…Hemostats promote platelet aggregation on the surface, creating a substrate for the coagulation cascade. To date, several hemostatic agents used in oral and periodontal surgery have been studied in the literature, in particular, oxidized regenerated cellulose [ 53 ]; resorbable gelatin [ 54 ]; collagen [ 55 ]; lysine analogues, serine protease inhibitors, and fibrin sealants [ 18 ]; fibrin glue [ 56 ]; cyanoacrylate-based glues [ 57 ]; human thrombin and thrombin gelatin-matrix [ 58 ]; tranexamic acid [ 59 , 60 ]; and chitosan [ 61 ]. Although these local hemostats have shown numerous advantages over the years, such as ease of use (flexibility and malleability), adaptability to a wide range of surgical procedures, rapid and complete resorption (within 7–14 days), and bacteriostatic action, they also have several disadvantages, including high cost, inflammatory reactions, and the lack of any autologous origin, which could lead to localized immunogenic reactions.…”