Efficacy of Tranexamic Acid Mouthrinse as a Haemostatic Agent after Extraction in Patients Who are on Anticoagulant and Anti Platelet Therapy

BACKGROUND: Optimal management of patients on anti platelet and anti coagulant who require oral surgery procedure has been controversial. Historically the surgeons have to balance the risk of thromboembolism by reducing or stopping anti platelet and anticoagulant therapy, against the risk of triggering excessive post extraction bleeding if anticoagulation or anti platelet is maintained at therapeutic levels during surgery. Patients on anti platelet and anticoagulants have impaired fibrin formation that is more susceptible to normal fibrinolysis and is believed to be the major cause of post extraction bleeding. In this study the �Efficacy of tranexamic acid mouth rinse as a haemostatic agent after extraction in patients who are on anticoagulant and anti platelet therapy� has been studied. AIMS AND OBJECTIVE: The aim of this study was to verify that this technique is a safe, simple, effective and an acceptable method of patient management. The objective was to identify potential risk factors that may increase the likelihood of bleeding. MATERIALS AND METHODS: One hundred consecutive anti platelet and anti coagulant patients with an International Normalized Ratio (INR) ranges between 1.9 and 3.5 on the day of surgery and who required dental extractions were recruited to this study. Following dental extraction, patients were instructed to use 5 milliliters of 10% tranexamic acid mouth rinse 4 times a day for 7 days, to record bleeding that required pressure to control and their mouth rinse usage. The researcher collected demographic data, details of the state of anti platelet and anticoagulation, details of the surgery and details of bleeding that required additional management. Data entry and analysis were conducted using the statistical computer programme SPSS (16.0). Descriptive statistics were produced for the sample demographics, the pre extraction profile, the post extraction bleeding profile, mouth rinse acceptance and utilization. Identification of potential risks that might increase the likelihood of bleeding was carried out using the paired and unpaired t test appropriate. RESULTS: Of the 100 patients treated, 17 reported bleeding at home on day 1 and 3 patients after day 1. The bleeding reported on these 20 patients was controlled at home only by tranexamic acid pressure pack alone. A further 9 patients reported to the researcher's dental surgery department for bleeding which was then controlled by administering other local haemostatic measures ( gelatin foam) with tranexamic acid pressure pack. No patients required hospital admission for systemic management of bleeding. Statistical analysis reveals significant risk factors for post extraction bleeding were as follows: � Patients in the age group of 41-60; � Pre extraction INR equal to and greater than 2.5 ; � Smoking. Factors not statistically significant for an increased risk of bleeding included: � The number of teeth removed; � Pre-extraction bleeding time and � Time on anti platelets and anticoagulants. CONCLUSION: On the basis of research and statistical analysis, it can be concluded that the post-operative use of tranexamic acid mouth rinses in patients who underwent dental extraction at therapeutic INR levels is a safe, simple, effective and an acceptable method of reducing post extraction bleeding.