The effectiveness of antifibrinolytic drugs as anti-Haemorrhage treatment for patients with anticoagulant during tooth extraction procedure: A review

Significant increases in major bleeding have been reported in patients receiving antithrombotic therapy who are undergoing dental extractions. To manage this risk, local hemostatic agents are commonly used, either to enhance the blood's natural clotting process or to mechanically limit external bleeding. These agents work by reducing the proteolytic activity of plasminogen activators, which prevents the formation of plasmin and inhibits clot dissolution. Among the various local hemostatic agents available, such as gelatin sponge, collagen sponge, oxidized cellulose, fibrin sealant, and tannic acid, tranexamic acid (TA) is the most frequently utilized. TA is widely employed both topically and as a mouthwash due to its proven efficacy in controlling bleeding. It can be administered in various forms, including as a dressing with gauze, local irrigation (250 mg/5mL solution), or as an oral suspension using crushed tablets (250 mg) mixed with saline or local anesthetic. Furthermore, it can be applied directly to the wound site for localized effect. The most common and effective approach involves using TA as a mouthwash before the extraction and continuing its application for 3-7 days post-extraction to minimize bleeding risk and promote hemostasis. The findings suggest that the localized application of antifibrinolytic agents can play a crucial role in ensuring safe dental extractions for anticoagulated patients.