title: 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.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Eduardo Costa Studart
authors.initials: EC
authors.lastname: Soares
authors.forename: Fábio Wildson Gurgel
authors.initials: FW
authors.lastname: Costa
authors.forename: Tácio Pinheiro
authors.initials: TP
authors.lastname: Bezerra
authors.forename: Carlos Bruno Pinheiro
authors.initials: CB
authors.lastname: Nogueira
authors.forename: Paulo Goberlânio
authors.initials: PG
authors.lastname: de Barros Silva
authors.forename: Saulo Hilton Botelho
authors.initials: SH
authors.lastname: Batista
authors.forename: Fabrício Bitu
authors.initials: FB
authors.lastname: Sousa
authors.forename: Cristiane
authors.initials: C
authors.lastname: Sá Roriz Fonteles
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001938:Brazil; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D011312:Pressure; D011446:Prospective Studies; D015503:Surgical Sponges; D014081:Tooth Extraction; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D015718:Fibrin Tissue Adhesive; D014859:Warfarin; D014148:Tranexamic Acid