Clinical Oral Investigations

, Volume 22, Issue 6, pp 2281–2289 | Cite as

Tranexamic acid as a local hemostasis method after dental extraction in patients on warfarin: a randomized controlled clinical study

  • Salomão Israel Monteiro Lourenço Queiroz
  • Valeria Damasceno Silvestre
  • Renata Monteiro Soares
  • Giordano Bruno Paiva Campos
  • Adriano Rocha Germano
  • José Sandro Pereira da Silva
Original Article



The present work is a controlled, blinded, and randomized clinical trial comparing hemostatic measures for the control of post-tooth extraction hemorrhage in patients on anticoagulation therapy with warfarin.

Materials and methods

The sample consisted of 37 patients (37.8% male and 62.2% female) with a mean age of 45.5 years. After randomization, 20 patients were allocated to the control group (conventional hemostasis measures) and 17 to the study group (addition of local tranexamic acid). All variables that could influence the outcome were similar between the groups and no significant difference was seen (p > 0.05).


In the assessment of immediate hemostasis, for the control group, the time to achieve cessation of bleeding was 9.1 (± 3.6) minutes. For the study group this was much lower, and this difference (6.018 / confidence interval of 95%, 4.677 to 7.359) was statistically significant (p < 0.001). In evaluating the control of intermediate hemorrhage, the use of tranexamic acid was more significantly associated with the absence of bleeding, especially in the first 24 h.

Conclusions and clinical relevance

Thus, this measure of local hemostasis in topical form with gauze compression and irrigation was shown to be more effective in reducing the time to attain immediate hemostasis, and in preventing intermediate hemorrhage.


Surgery, oral Oral hemorrhage Warfarin Tranexamic acid 



The work was supported by the Department of Oral & Maxillofacial Surgery of UFRN in Natal/RN, the Brazil and Hemonorte of Rio Grande do Norte, Dalton Cunha.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Souto JC, Oliver A, Zuazu-Jausoro I, Vives A, Fontcubertas J (1996) Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg 54(1):27–32. PubMedCrossRefGoogle Scholar
  2. 2.
    Blinder D, Manor Y, Martinowitz U, Taicher S (2001) Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. J Oral Maxillofac Surg 30(6):518–521. CrossRefGoogle Scholar
  3. 3.
    Karsli ED, Erdogan O, Esen E, Acarturk E (2011) Comparison of the effects of warfarin and heparin on bleeding caused by dental extraction: a clinical study. J Oral Maxillofac Surg 69(10):2500–2507. PubMedCrossRefGoogle Scholar
  4. 4.
    Kearon C, Hirsh J (1997) Management of anticoagulation before and after elective surgery. N Engl J Med 336(21):1506–1511. PubMedCrossRefGoogle Scholar
  5. 5.
    Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E (2004) The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3):204–233CrossRefGoogle Scholar
  6. 6.
    Bailey BM, Fordyce AM (1983) Complications of dental extraction in patients receiving warfarin anticoagulant therapy: a controlled trial. Br Dent J 155(9):308–310. PubMedCrossRefGoogle Scholar
  7. 7.
    Borea G, Montebugnoli L, Capuzzi P, Magelli C (1993) Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol 75(1):29–31. PubMedCrossRefGoogle Scholar
  8. 8.
    Ramstrom G, Sindet-Pedersen S, Hall G, Blomback M, Alander U (1993) Prevention of postsurgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 51(11):1211–1216. PubMedCrossRefGoogle Scholar
  9. 9.
    Devani P, Laverhy M, Howell CJT (1998) Dental extractions in patients on warfarin: is alteration of the anticoagulant regime necessary? Br J Oral Maxillofac Surg 36(2):107–111. PubMedCrossRefGoogle Scholar
  10. 10.
    Blinder D, Manor Y, Martinowitz U, Taicher S, Hashomer T (1999) Dental extractions in patients maintained on continued oral anticoagulant: comparison of local hemostatic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88(2):137–140. PubMedCrossRefGoogle Scholar
  11. 11.
    Bernardoni-Socorro C, Arteaga-Vizcaino M, Villamizar Y, Diez-Ewald M, Vizcaíno-Salazar G, Torres-Guerra E, Quintero J (1998) Mouth-washing with tranexamic acid in patients treated with oral anticoagulants subjected to oral surgery procedures. Investig Clin 39(2):77–83Google Scholar
  12. 12.
    Queiroz SIML, Alves HS, de Assis GM, Conceicao TS, Germano AR, da Silva JS (2016) An evaluation of the efficacy of local hemostatic measures in dental patients taking oralanticoagulants: a critical review of the literature over the past two decades. Curr Clin Pharmacol 11(4):230–240.
  13. 13.
    Bublitz R, Sommer S, Weingart D, Bäuerle K, Both A (2000) Gestão de hemostáticos em feridas de pacientes Marcumar. Lã de Colágeno vs ácido tranexâmico. Mund Kiefer Gesichtschir 4(4):240–244. PubMedCrossRefGoogle Scholar
  14. 14.
    Halfpenny W, Fraser JS, Adlam DM (2001) Comparison of two hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92(3):257–259. PubMedCrossRefGoogle Scholar
  15. 15.
    Cannon PD, Dharmar VT (2003) Minor oral surgical procedures in patients on oral anticoagulants—a controlled study. Aust Dent J 48(2):115–118. PubMedCrossRefGoogle Scholar
  16. 16.
    Campbell JH, Alvarado F, Murray RA (2000) Anticoagulation and minor oral surgery: should the anticoagulation regimen be altered? J Oral Maxillofac Surg 58(2):131–135. PubMedCrossRefGoogle Scholar
  17. 17.
    Bajkin BV, Popovic SL, Selakovic SDJ (2009) Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth. J Oral Maxillofac Surg 67(5):990–995. PubMedCrossRefGoogle Scholar
  18. 18.
    Bajkin BV, Bajkin IA, Petrovic BB (2012) The effects of combined oral anticoagulant-aspirin therapy in patients undergoing tooth extractions: a prospective study. JADA 43(7):771–776Google Scholar
  19. 19.
    Scully C, Wolff A (2002) Oral surgery in patients on anticoagulant therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94(1):57–64. PubMedCrossRefGoogle Scholar
  20. 20.
    Al-Belasy FA, Amer MZ (2003) Hemostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery. J Oral Maxillofac Surg 61(12):1405–1409. PubMedCrossRefGoogle Scholar
  21. 21.
    Carter G, Goss A, Lloyd J, Tocchetti R (2003) Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study. J Oral Maxillofac Surg 61(12):1432–1435. PubMedCrossRefGoogle Scholar
  22. 22.
    Morimoto Y, Niwa H, Minematsu K (2008) Hemostatic management of tooth extractions in patients on oral antithrombotic therapy. J Oral Maxillofac Surg 66(1):51–57. PubMedCrossRefGoogle Scholar
  23. 23.
    Dantas AK, Deboni MCZ, Piratininga JL (2009) Dental surgery in patients on oral anticoagulation therapy. Rev Bras Hematol Hemoter 31(5):337–340. CrossRefGoogle Scholar
  24. 24.
    Chopra H, Rehah P, Mehra K, Kakkar A (2009) A randomized, double-blind placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. J Oral Maxillofac Surg 8(4):350–355CrossRefGoogle Scholar
  25. 25.
    Marques MS, Almeida AP, Lopes MG (2005) A terapêutica anticoagulante em cirurgia oral—revisão da literatura. Ver Port Estomatol Med Dent Cir Maxilofac 46:1Google Scholar
  26. 26.
    Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW (2002) Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg 40(3):248–252. PubMedCrossRefGoogle Scholar
  27. 27.
    Doonquah L, Mitchell AD (2012) Oral surgery for patients on anticoagulant therapy: current thoughts on patient management. Dent Clin N Am 56(1):25–41. PubMedCrossRefGoogle Scholar
  28. 28.
    Wahl M (2000) Myths of dental surgery in patients receiving anticoagulant therapy. J Am Dent Assoc 131(1):77–81. PubMedCrossRefGoogle Scholar
  29. 29.
    Jeské AH, Suchko GD (2003) Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. J Am Dent Assoc 134(11):1492–1497. PubMedCrossRefGoogle Scholar
  30. 30.
    Hirsh J, Guyatt G, Albers GW, Harrington R, Schünemann HJ, American College of Chest Physicians (2008) Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6):71–109CrossRefGoogle Scholar
  31. 31.
    Sacco R, Sacco M, Carpenedo M, Mannucci PM (2007) Oral surgery in patients on oral anticoagulant therapy: a randomized comparison of different intensity targets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104(1):18–21CrossRefGoogle Scholar
  32. 32.
    Aframian DJ, Lalla RV, Petterson DE, Farmington CT (2007) Management of dental patients taking common hemostasis altering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(1):1–11CrossRefGoogle Scholar
  33. 33.
    Gaspar R, Brenner B, Ardekian L, Peed M, Laufer D (1997) Use of tranexamic acid mouthwash to prevent postoperative bleeding in oral surgery patients on oral anticoagulant medication. Quintessence Int 28(6):375–379PubMedGoogle Scholar
  34. 34.
    Akopov SE, Suzuki S, Fredieu A, Kidwell CS, Saver JL, Cohen SN (2005) Withdrawal of warfarin prior to a surgical procedure: time to follow the guidelines? Cerebrovasc Dis 19(5):337–342. PubMedCrossRefGoogle Scholar
  35. 35.
    Kämmerer PW, Frerich B, Liese J, Schiegnitz E, Al-Nawas B (2015) Oral surgery during therapy with anticoagulants—a systematic review. Clin Oral Investig 19(2):171–180. PubMedCrossRefGoogle Scholar
  36. 36.
    Eichhorn W, Burkert J, Vorwig O, Blessmann M, Cachovan G, Zeuch J, Eichhorn M, Heiland M (2012) Bleeding incidence after oral surgery with continued oral anticoagulation. Clin Oral Investig 16(5):1371–1376. PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Salomão Israel Monteiro Lourenço Queiroz
    • 1
  • Valeria Damasceno Silvestre
    • 1
  • Renata Monteiro Soares
    • 2
  • Giordano Bruno Paiva Campos
    • 1
  • Adriano Rocha Germano
    • 1
  • José Sandro Pereira da Silva
    • 1
  1. 1.Departamento de OdontologiaUniversidade Federal do Rio Grande do Norte (UFRN)NatalBrazil
  2. 2.Hemocentro Dalton Cunha (Hemonorte)NatalBrazil

Personalised recommendations