Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease : a prospective, randomized study

Abstract

Introduction Oral anticoagulants are widely prescribed drugs. Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy. The purpose of this study was to evaluate the incidence of bleeding complications after dental extractions in patients on anticoagulant therapy (warfarin) in whom different local hemostatic methods were used. Material and methods Patients using warfarin and requiring extractions of at least two teeth were screened to participate in this prospective, randomized study. Extraction sites were con- sidered as sampling units (statistically representative sample size) and were allocated to one of the three study groups (G1 — 4.8 % tranexamic acid; G2 — fibrin sponge; and G3 — no local hemostatic agents). Results Eighty-four extraction sites were obtained from pa- tients with mitral valve prolapse (47.4 %), prosthetic cardiac valve (23.7 %), venous thromboembolism (21.1 %), and pulmonary embolism (5.2 %). International normalized ratio (INR) values ranged between 2.1 and 3.1 (mean 2.51±0.1). Postoperative bleeding was observed in four surgical sites ( p <0.001) and was mainly in older patients ( p =0.005). Discussion The three local hemostatic protocols were similar- ly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin. The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with antico- agulant therapy.