An Evaluation of the Efficacy of Local Hemostatic Measures in Dental Patients Taking Oral Anticoagulants: A Critical Review of the Literature Over the Past Two Decades.

The increased risk of bleeding observed in patients on oral anticoagulant therapy (OAT) undergoing outpatient oral surgical procedures has been reported in the literature and remains a major concern in the care of these patients. This is still of great concern to dental surgeons that discontinuing OAT medication increases the risk of thromboembolism, while maintaining the therapeutic dose increases the risk of hemorrhage. Several local hemostatic measures have been used to control bleeding in patients on OAT. However, the effectiveness of these measures has not been thoroughly investigated. The aim of this study is to evaluate the efficacy of local hemostatic measures in patients taking oral anticoagulants. Various databases were searched using the key terms. Selection criteria included publications in English, Spanish, or Portuguese within the last 20 years. The titles and abstracts of papers were initially screened, and reports of 18 clinical trials were selected for a critical review and scored according to CONSORT 2010 guidelines. The data extracted from these trials represented 1821 patients receiving OAT, 4116 tooth extractions, and 144 cases of postoperative bleeding. In most studies, there were no differences in the effectiveness of various local hemostatic measures, and only tranexamic acid was proven effective as compared with a placebo group. The reported INR values varied widely among studies; the lowest INR value was 0.9 and the highest was 5.0. All local hemostatic methods showed low rates of bleeding; and when bleeding occurred, the use of these methods was essential for controlling postoperative bleeding. While local hemostatic measures appear to be effective in controlling postoperative bleeding, additional controlled randomized clinical trials are needed to assess the true effectiveness of these measures in patients taking OAT.