Anna Ockerman1,2, Isabel Miclotte2, Maarten Vanhaverbeke3, Peter Verhamme3, Laura-Lien Poortmans1, Thomas Vanassche3, Constantinus Politis1, Reinhilde Jacobs4,5. 1. OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. 2. Department of Oral & Maxillofacial Surgery, University of Leuven, Leuven, Belgium. 3. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. 4. OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. reinhilde.jacobs@uzleuven.be. 5. Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden. reinhilde.jacobs@uzleuven.be.
Abstract
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.
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.
Entities:
Keywords:
Antithrombotic treatment; Bleeding; Local haemostatics; Prevention; Tooth removal