Tranexamic Acid in People on Anticoagulants Undergoing Minor Oral Surgery or Dental Extractions

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 253 subjects on continuous treatment with vitamin K antagonists (VKAs) undergoing minor oral surgery or dental extractions. No studies in people on direct oral anticoagulants (DOACs) were found.Two studies compared the antifibrinolytic agent tranexamic acid (TXA) with placebo; the treatment regimen included irrigation with 10 mL 4.8% TXA solution intra-operatively before suturing, and rinsing with 10 mL 4.8% TXA mouthwash for 2 minutes 4 times daily for 7 days postoperatively. One study compared TXA with gelatin sponge and sutures, and one study compared TXA with dry gauze compression. In all included studies INR values were within therapeutic range and TXA was applied locally.

There was a statistically significant beneficial effect with TXA compared to placebo regarding the number of major postoperative bleeding episodes requiring intervention (RD -0.25, 95% CI -0.36 to -0.14; 2 studies, n=128). There was no difference between the TXA and the standard care (gelatin sponge and sutures or dry gauze compression) group (RD 0.02, 95% CI -0.07 to 0.11; 2 studies, n=125). The combined RD of all included studies was -0.13 (95% CI -0.30 to 0.05; 4 studies, n=253; statistical heterogeneity I² =80%). There were no side effects of antifibrinolytic therapy that required treatment withdrawal (n=128).