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.

Keywords: dental care; direct oral anticoagulants; mouthwash; postoperative bleeding; tranexamic acid; vitamin K antagonists.

Figure 1

PRISMA flowchart depicting the study selection process. The figure enlists the number of studies identified, the screening process of the studies, and the inclusion process.

Figure 2

Risk difference (RD) for postoperative bleeding outcomes across the entire cohort of included patients [22,23,24,25,26]. Heterogeneity: Chi² = 9.43, df = 4 (p = 0.05); I² = 58%. Test for overall effect: Z = 1.93 (p = 0.05).

Figure 3

Funnel plot for the visual representation of publication bias.

Figure 4

Risk of bias assessment of RCTs using the ROB-2 tool. Traffic light plot of study-by-study bias assessment. Weighted summary plot of the overall type of bias encountered in all studies [9,10,11,12,13].