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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

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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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Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Oral and Maxillofacial Surgery, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Eduardo Costa Studart Soares

  2. Division of Oral Radiology, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Fábio Wildson Gurgel Costa

  3. Division of Oral and Maxillofacial Surgery Residency Program of the Walter Cantídio University Hospital from Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Tácio Pinheiro Bezerra, Carlos Bruno Pinheiro Nogueira & Saulo Hilton Botelho Batista

  4. Division of Stomatology, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Paulo Goberlânio de Barros Silva

  5. Division of Oral Pathology, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Fabrício Bitu Sousa

  6. Division of Pediatric, Department of Clinical Dentistry, School of Dentistry, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Cristiane Sá Roriz Fonteles

  7. Post-program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Rua Cap. Francisco Pedro S/N, Rodolfo Teófilo, Fortaleza, CE, 60430-170, Brazil

    Fábio Wildson Gurgel Costa

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  1. Eduardo Costa Studart Soares
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Correspondence to Fábio Wildson Gurgel Costa.

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Soares, E.C.S., Costa, F.W.G., Bezerra, T.P. et al. 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. Oral Maxillofac Surg 19, 209–216 (2015). https://doi.org/10.1007/s10006-014-0479-9

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  • DOI: https://doi.org/10.1007/s10006-014-0479-9

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