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Review
. 2022 Dec 13;10(12):2523.
doi: 10.3390/healthcare10122523.

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

Asma Zaib  1 , Muhammad Shaheryar  2 , Muhammad Shakil  3 , Azza Sarfraz  4 , Zouina Sarfraz  5 , Ivan Cherrez-Ojeda  6
Affiliations
Review

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

Asma Zaib et al. Healthcare (Basel). .

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.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
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
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
Figure 3
Funnel plot for the visual representation of publication bias.
Figure 4
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].
See this image and copyright information in PMC

References

    1. Task Force Members. Lip G.Y.H., Windecker S., Huber K., Kirchhof P., Marin F., Ten Berg J.M., Haeusler K.G., Boriani G., Capodanno D., et al. Management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting with Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary or Valve Interventions: A Joint Consensus Document of the European Society of Cardiology Working Group On. Eur. Heart J. 2014;35:3155–3179. - PubMed
    1. Kumbhani D.J., Cannon C.P., Beavers C.J., Bhatt D.L., Cuker A., Gluckman T.J., Marine J.E., Mehran R., Messe S.R., Patel N.S., et al. 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients with Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or with Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J. Am. Coll. Cardiol. 2021;77:629–658. - PubMed
    1. Chan N., Sobieraj-Teague M., Eikelboom J.W. Direct Oral Anticoagulants: Evidence and Unresolved Issues. Lancet. 2020;396:1767–1776. doi: 10.1016/S0140-6736(20)32439-9. - DOI - PubMed
    1. Caturano A., Galiero R., Pafundi P.C. Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants. Medicina. 2019;55:617. doi: 10.3390/medicina55100617. - DOI - PMC - PubMed
    1. Mingarro-de-León A., Chaveli-López B., Gavaldá-Esteve C. Dental Management of Patients Receiving Anticoagulant and/or Antiplatelet Treatment. J. Clin. Exp. Dent. 2014;6:e155–e161. doi: 10.4317/jced.51215. - DOI - PMC - PubMed

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