title: Topical application of tranexamic acid in anticoagulated patients undergoing minor oral surgery: A systematic review and meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  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.
  
  
  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 0.05-0.36; 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.
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Sara Juliana de Abreu
authors.initials: SJ
authors.lastname: de Vasconcellos
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Thiago
authors.initials: T
authors.lastname: de Santana Santos
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Daniele Machado
authors.initials: DM
authors.lastname: Reinheimer
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: André Luis
authors.initials: AL
authors.lastname: Faria-E-Silva
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Maria de Fátima Batista
authors.initials: MF
authors.lastname: de Melo
authors.affiliation: Universidade Federal de Sergipe, Sergipe, Brazil. Electronic address: martins-filho@ufs.br.
authors.forename: Paulo Ricardo Saquete
authors.initials: PR
authors.lastname: Martins-Filho
mesh_terms: D000287:Administration, Topical; D000925:Anticoagulants / Q000009:adverse effects*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Evidence-based dentistry; Hemorrhage; Oral surgical procedures; Tranexamic acid