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

Summary 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 RC...

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Published in:Journal of cranio-maxillo-facial surgery 2017-01, Vol.45 (1), p.20-26
Main Authors: Juliana de Abreu de Vasconcellos, Sara, DDS, MSc, de Santana Santos, Thiago, DDS, MSc, PhD, Reinheimer, Daniele Machado, DDS, Faria-e-Silva, André Luis, DDS, MSc, PhD, de Fátima Batista de Melo, Maria, DDS, MSc, PhD, Martins-Filho, Paulo Ricardo Saquete, Prof
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Language:English
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Summary:Summary 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 to 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.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2016.10.001