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

Soares, Eduardo Costa Studart; Costa, Fábio Wildson Gurgel; Bezerra, Tácio Pinheiro; Nogueira, Carlos A.; Silva, Paulo Goberlânio de Barros; Batista, Saulo Hilton Botelho; Sousa, Fabrício Bitú; Fonteles, Cristiane Sá Roriz

doi:10.1007/s10006-014-0479-9

Cited by 28 publications

(22 citation statements)

References 35 publications

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“…However, in the first hour after severe injury, hyperfibrinolysis can occur which can lead to further bleeding, and TXA acts to block this [ 15 , 16 ]. Topical TXA may be more beneficial especially in the presence antithrombotic therapy, when capillary or venous ooze is more pronounced [ 17 , 18 ]. In addition, TXA may have positive impact on platelet functions by inhibiting the conversion of plasminogen to plasmin which impairs platelet functions [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid?

Beton

Sarıçam

Kaya

et al. 2016

BMC Cardiovasc Disord

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BackgroundThe perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment.MethodsWe conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared.ResultsA total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 ± 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496–47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012–0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group.ConclusionThe present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0251-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid?

Beton

Sarıçam

Kaya

et al. 2016

BMC Cardiovasc Disord

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“…The exact effect of TXA has been a point of discussion. Some studies (16,19), reported a lower bleeding rate when used after dental procedures, while another (20), found no differences in bleeding between exposure groups. Most of these studies were relatively small though, with heterogeneous periprocedural management and with very few bleeding complications, thus likely to be underpowered to find differences in outcomes between exposures if present.…”

Section: Discussionmentioning

confidence: 99%

Predictors of oral cavity bleeding and clinical outcome after dental procedures in patients on vitamin K antagonists

Biedermann¹,

Rademacher²,

Hazendonk³

et al. 2017

Thromb Haemost

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Patients on vitamin K antagonists (VKA) often undergo invasive dental procedures. International guidelines consider all dental procedures as low-risk procedures, while bleeding risk may differ between standard low-risk (e. g. extraction 1-3 elements) and extensive high-risk (e. g. extraction of >3 elements) procedures. Therefore current guidelines may need refinement. In this cohort study, we identified predictors of oral cavity bleeding (OCB) and evaluated clinical outcome after low-risk and high-risk dental procedures in patients on VKA. Perioperative management strategy, procedure risk, and 30-day outcomes were assessed for each procedure. We identified 1845 patients undergoing 2004 low-risk and 325 high-risk procedures between 2013 and 2015. OCB occurred after 67/2004 (3.3 %) low-risk and 21/325 (6.5 %) high-risk procedures (p=0.006). In low-risk procedures, VKA continuation with tranexamic acid mouthwash was associated with a lower OCB risk compared to continuation without mouthwash [OR=0.41, 95 %CI 0.23-0.73] or interruption with bridging [OR=0.49, 95 %CI 0.24-1.00], and a similar risk as interruption without bridging [OR=1.44, 95 %CI 0.62-3.64]. In high-risk procedures, VKA continuation was associated with an increased OCB risk compared to interruption [OR=3.08, 95 %CI 1.05-9.04]. Multivariate analyses revealed bridging, antiplatelet therapy, and a supratherapeutic or unobjectified INR before the procedure as strongest predictors of OCB. Non-oral cavity bleeding (NOCB) and thromboembolic event (TE) rates were 2.1 % and 0.2 %. Bridging therapy was associated with a two-fold increased risk of NOCB [OR=1.93, 95 %CI 1.03-3.60], but not with lower TE rates. In conclusion, predictors of OCB were mostly related to perioperative management and differed between low-risk and high-risk procedures. Perioperative management should be differentiated accordingly.

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“…A la luz del metaanálisis realizado en esta revisión sistemática, podemos mencionar objetivamente que existe una tendencia hacia un aumento de los eventos hemorrágicos en los grupos de pacientes en los cuales no se lleva a cabo una modificación de la terapia anticoagulante oral frente a procedimientos de cirugía oral. Sin embargo, el aumento no es estadísticamente significativo y según lo reportado por los diferentes estudios, en ningún caso se reportaron sangrados incoercibles ni estuvo comprometida la integridad de los pacientes a causa de otras reacciones adversas, siendo las medidas locales de hemostasia un recurso suficiente para la contención de los episodios hemorrágicos (10,11) , resultando finalmente en una diferencia que clínicamente tampoco es significativa.…”

Section: Discussionunclassified

“…La necesidad de tratamiento odontológico en relación a la cirugía oral constituye un constante dilema para el manejo de estos pacientes bajo la terapia anticoagulante oral (TACO), debido a que no existe un estricto consenso respecto a la conducta clínica (6) , existiendo una corriente que asume un elevado riesgo hemorrágico, suspendiendo habitualmente la terapia un par de días previo a la intervención y retomándola un día después, en general en acuerdo con el médico tratante, versus otra corriente que mantiene la terapia dentro de los valores objetivos, previo control con exámenes de laboratorio, con el fin de evitar el riesgo tromboembólico que supone la suspensión del fármaco (1,(7)(8)(9) . En general, la controversia está sustentada en la capacidad de controlar una hemorragia con medidas hemostáticas locales durante los procedimientos de cirugía oral (10) continuando el TACO, dado que estos pacientes mantienen su capacidad hemostática funcional, pero disminuida (11) ; versus el otro punto de vista, donde algunos tratantes prefieren eliminar la influencia del medicamento y con ello, la posibilidad de hemorragia, asumiendo el mayor riesgo tromboembólico por el cual éste fue indicado. Es importante considerar que el TACO ha demostrado reducir la probabilidad de aparición de primeros eventos tromboembólicos en alrededor de un 70% y en aproximadamente 90% las recurrencias de los mismos (12,13) .…”

Section: Introductionunclassified

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis.

Villanueva

Vergara

Núñez

et al. 2018

Rev. Clin. Periodoncia Implantol. Rehabil. Oral

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resumen introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93-2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral. Palabras clave Cirugía oral, Hemorragia, Anticoagulantes orales. rev. clin. Periodoncia implantol. rehabil. Oral vol. 11(2); 121-127, 2018. abstract introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. materials and methods: A search was performed using CENTRAL,Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. results: A total of 5 studies were included based on inclusion criteria (549 patients). The metaanalysis showed that the maintenance of OAT does not increasethe risk of postoperative bleeding (relative risk [RR] 1.41 [0.93-2.16]; 95% CI p= 0,11)compared with the discontinuation of therapy. conclusion: Although a larger quantityof oral postoperative bleeding episodes were found in patients continuing with OATcompared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.

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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

Cited by 28 publications

References 35 publications

Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid?

Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid?

Predictors of oral cavity bleeding and clinical outcome after dental procedures in patients on vitamin K antagonists

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis.

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