Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials.

Abstract

PURPOSE:

To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy and safety of topical tranexamic acid (TXA) to prevent postoperative bleeding in anticoagulated patients undergoing minor oral surgery.

MATERIAL AND METHODS:

We analyzed RCTs comparing the use of topical TXA versus other topical hemostatic agents or placebo solutions for minor oral surgeries. We assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. The pooled relative risk (RR) was calculated for the effect of topical application of TXA on postsurgical bleeding.

RESULTS:

Five RCTs were included in the study. The combined RR for the number of patients receiving TXA in comparison to the control group was 0.13 (95% CI 0.05-0.36; P = 0.01), indicating a protective effect of topical TXA on bleeding after minor oral surgeries. Subgroup analysis revealed that topical TXA was effective in preventing postsurgical bleeding compared to placebo and epsilon-aminocaproic acid. No cases of thromboembolic events were reported.

CONCLUSIONS:

Currently available evidence suggests that surgical site irrigation with TXA followed by mouthwash during the first postoperative week is safe and may reduce the risk of bleeding after minor oral surgeries in anticoagulated patients.

• Authors: Sara Juliana de Abreu de Vasconcellos, Thiago de Santana Santos, Daniele Machado Reinheimer, André Luis Faria-E-Silva, Maria de Fátima Batista de Melo, Paulo Ricardo Saquete Martins-Filho
• Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery (J Craniomaxillofac Surg) Vol. 45 Issue 1 Pg. 20-26 (Jan 2017) ISSN: 1878-4119 [Electronic] Scotland
• PMID: 27840121 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2016. Published by Elsevier Ltd.

Chemical References

• Anticoagulants
• Antifibrinolytic Agents
• Tranexamic Acid

Topics

• Administration, Topical
• Anticoagulants (adverse effects)
• Antifibrinolytic Agents (administration & dosage, therapeutic use)
• Humans
• Oral Surgical Procedures (adverse effects, methods)
• Postoperative Hemorrhage (prevention & control)
• Tranexamic Acid (administration & dosage, therapeutic use)