Supportive topical tranexamic acid application for hemostasis in oral bleeding events - Retrospective cohort study of 542 patients.

Abstract

PURPOSE:

Tranexamic acid (TXA) is widely used in the prevention of postsurgical oral bleeding. Tranexamic acid in addition to further surgical measures is widely utilized in prevention of post-surgical oral bleeding. The aim of the present study was to investigate: Can oral hemostasis be achieved by merely compression and topical application of tranexamic acid in different anticoagulant regimes among patients attending a general emergency department? Where are the limits to this procedure? Which has the greater impact on surgeons' choice for an invasive hemostatic approach-bleeding quality or oral anticoagulant therapy?

MATERIALS AND METHODS:

A retrospective cohort study of 542 patients who consecutively received treatment for oral bleeding was performed. We surveyed the values of the diverse hemostatic approaches. Special attention was granted to patient anticoagulant regimen and quality of the oral bleeding event.

RESULTS:

A total of 199 of 542 (36.7%) oral bleeding events were stopped by compression with a gauze or gauze soaked with TXA (4.8%). Stopping an oral bleeding event with wound compression can be improved by factor 1.6 if the gauze is soaked with tranexamic acid (4.8%), p ≤ 0.05. LMWH presented significantly more moderate bleeding than bloody oozing of the wound, p < 0.05. The quality of bleeding had a strong influence on oral surgeons' decisions to apply further surgical means. Sutures and native collagen fleeces were the favored methods to stop moderate and severe bleeding (p < 0.05).

CONCLUSION:

Topical application of TXA aids as a useful supportive tool to stop mild bleeding events such as the bloody oozing of an oral wound. The quality of an oral bleeding episode should be considered in the choice of hemostatic measure. Hemostatic approaches should begin with the least invasive procedure. TXA is a helpful tool.

• Authors: Matthias Zirk, Max Zinser, Johannes Buller, Viktor Bilinsky, Timo Dreiseidler, Joachim E Zöller, Matthias Kreppel
• Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery (J Craniomaxillofac Surg) Vol. 46 Issue 6 Pg. 932-936 (Jun 2018) ISSN: 1878-4119 [Electronic] Scotland
• PMID: 29627368 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anticoagulants
• Heparin, Low-Molecular-Weight
• Tranexamic Acid

Topics

• Administration, Oral
• Administration, Topical
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Blood Loss, Surgical (prevention & control)
• Emergency Treatment
• Female
• Hemostasis (drug effects)
• Hemostasis, Surgical (methods)
• Heparin, Low-Molecular-Weight (therapeutic use)
• Humans
• Male
• Middle Aged
• Oral Hemorrhage (prevention & control)
• Postoperative Hemorrhage (prevention & control)
• Retrospective Studies
• Surgery, Oral
• Tooth Extraction (adverse effects)
• Tranexamic Acid (therapeutic use)
• Treatment Outcome