Effect of Tranexamic acid following tooth extractions in patients treated with non-vitamin K antagonist oral anticoagulants

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Created On: 14/06/2021

Effect of Tranexamic acid following tooth extractions in patients treated with non-vitamin K antagonist oral anticoagulants

To study the effectiveness of tranexamic acid (TXA) 10% mouthwash for bleeding after tooth extraction in patients with non-vitamin K oral anticoagulants (NOACs) therapy.

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Key take away

Patients with non-vitamin K oral anticoagulants usually suffer from bleeding following tooth extraction. Although the tranexamic acid 10% mouthwash was no good for bleeding during the procedure or untimely bleeding after the extraction as observed from this randomised study, but in case of multiple teeth extractions, it lessened delayed and post-operative bleeding.

Background

To study the effectiveness of tranexamic acid (TXA) 10% mouthwash for bleeding after tooth extraction in patients with non-vitamin K oral anticoagulants (NOACs) therapy.

Method

The patients were allocated to either TXA 10% (106 patients) or placebo (112 patients) group mouthwash and were directed to use the mouthwash before the tooth extraction and 3 times daily for 3 days after the extraction. The number of patients with any oral bleeding after the tooth extraction for a week was the primary outcome. Bleeding during the procedure, untimely, and delayed bleeding, and the safety outcomes comprising of all thrombotic events were the secondary outcomes.

Result

Out of total 218 patients under consideration, bleeding after the extraction was noticed in 28 (26.4%) patients in TXA and 32 (28.6%) patients in placebo group. Patients in TXA group had 46 bleeds compared to 85 placebo.

TXA did not decrease the rate of bleeding during the procedure and untimely bleeding.

However, the TXA group had delayed bleeding and reduced bleeding following more than one dental extractions.

A patient in the placebo group had a brief ischemic attack (mini stroke) while interfering the NOAC treatment in planning for the extraction.

Conclusion

Compared to placebo, the use of TXA did not seem to lessen bleeding during the procedure or untimely postoperative bleeding in patients on NOACs undergoing tooth extraction. But, in case of multiple teeth extractions, TXA did lessen delayed bleeds and post-operative bleeding.

Source:

PloS Medicine

Link:

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003601

Article:

Tranexamic acid and bleeding in patients treated with non-vitamin K oral anticoagulants undergoing dental extraction: The EXTRACT-NOAC randomized clinical trial