Local haemostatic measures after tooth removal in patients on antithrombotic therapy: a systematic review

• Published in: Clinical oral investigations Vol. 23; no. 4; pp. 1695 - 1708
• Main Authors: Ockerman, Anna, Miclotte, Isabel, Vanhaverbeke, Maarten, Verhamme, Peter, Poortmans, Laura-Lien, Vanassche, Thomas, Politis, Constantinus, Jacobs, Reinhilde
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2019; Springer Nature B.V
• Subjects: Acids; Antagonists; Antifibrinolytic Agents - therapeutic use; Bleeding; Calcium sulfate; Clinical trials; Dentistry; Fibrinolytic Agents - therapeutic use; Gelatin; Hemostatics - therapeutic use; Humans; Medicin och hälsovetenskap; Medicine; Mouthwashes; Original Article; Plant extracts; Standardization; Systematic review; Teeth; Thromboembolism; Tooth Extraction; Tranexamic Acid; Vitamin K; Prevention; Tooth removal; Antithrombotic treatment; Local haemostatics; Bleeding
• ISSN: 1432-6981; 1436-3771; 1436-3771
• DOI: 10.1007/s00784-018-2576-x

Objective
The interruption of antithrombotics prior to tooth removal because of the fear of bleeding or following postoperative bleeding increases the risk of thromboembolic events. The aim of this systematic review was to investigate which local haemostatic measures can effectively prevent postoperative bleeding in patients continuing oral antithrombotics.
Methods
A systematic review was conducted by running a search in PubMed, Embase, Web of Science and Cochrane Library. Clinical randomised trials investigating bleeding and haemostatics after tooth removal in patients on antithrombotics were identified.
Results
In total, 15 articles were included. The investigated haemostatics included gauze pressure, tranexamic acid-soaked gauze, sponges, glue, calcium sulfate, plant extract Ankaferd Blood Stopper, epsilon-aminocaproic acid and tranexamic acid. In patients treated with vitamin K antagonists, tranexamic acid mouthwash significantly reduced bleeding compared to placebo. Further, histoacryl glue was proven better than gelatin sponges. Other studies failed to show significant differences between haemostatics, but bleeding events were low.
Conclusions
Tranexamic acid seems to effectively reduce bleeding, although its superiority to other haemostatics was not proven. In view of the rapidly changing landscape of antithrombotics and the lack of standardization of bleeding outcome, adequately powered clinical studies are required to optimise postoperative management in patients on antithrombotics.
Clinical relevance
In order to optimise postoperative management, the best haemostatics over different patient groups have to be identified and implemented in guidelines.