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01.06.2015 | Original Article | Ausgabe 2/2015

Oral and Maxillofacial Surgery 2/2015

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

Zeitschrift:
Oral and Maxillofacial Surgery > Ausgabe 2/2015
Autoren:
Eduardo Costa Studart Soares, Fábio Wildson Gurgel Costa, Tácio Pinheiro Bezerra, Carlos Bruno Pinheiro Nogueira, Paulo Goberlânio de Barros Silva, Saulo Hilton Botelho Batista, Fabrício Bitu Sousa, Cristiane Sá Roriz Fonteles

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 considered 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 patients 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 similarly 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 anticoagulant therapy.

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