Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
Office of Research Affairs, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Sci Rep. 2023 Aug 2;13(1):12519. doi: 10.1038/s41598-023-39023-7.
This network meta-analysis was done to thoroughly evaluate the available literature on the use of different hemostatic agents for dental extraction in patients under oral antithrombotic therapy, aiming to identify the agent with the best/worst performance in bleeding control. Considering that such patients have a higher risk of bleeding, choosing the right hemostatic is essential. Twenty-three randomized clinical trials articles were included after completing the literature search. Cyanoacrylate tissue adhesive showed a reduction in the odds of postoperative bleeding events compared with conventional methods (i.e., gauze/cotton pressure, sutures), with a tendency toward a statistical significance (OR 0.03, P = 0.051). Tranexamic acid was the only agent that demonstrated a significantly lower risk of developing postoperative bleeding events (OR 0.27, P = 0.007). Interestingly, chitosan dental dressing and collagen plug had the shortest time to reach hemostasis. However, they ranked last among all hemostatic agents, regarding bleeding events, revealing higher odds than conventional measures. Therefore, it is concluded that the use of cyanoacrylate tissue adhesive and tranexamic acid gives favorable results in reducing postoperative bleeding events following dental extractions. Although chitosan dental dressing and collagen exhibited a faster time to reach hemostasis, they led to a higher occurrence of bleeding events.
本网络荟萃分析旨在全面评估口腔抗血栓治疗患者拔牙中使用不同止血剂的现有文献，以确定在控制出血方面表现最佳/最差的止血剂。考虑到此类患者出血风险较高，选择合适的止血剂至关重要。在完成文献检索后，共纳入了 23 篇随机临床试验文章。与常规方法（即纱布/棉花压力、缝合）相比，氰基丙烯酸酯组织粘合剂显示术后出血事件的发生几率降低，且有统计学意义的趋势（OR 0.03，P=0.051）。氨甲环酸是唯一显示术后出血事件风险显著降低的药物（OR 0.27，P=0.007）。有趣的是，壳聚糖牙用敷料和胶原蛋白塞达到止血的时间最短。然而，在所有止血剂中，它们在出血事件方面的排名最后，显示出比常规措施更高的几率。因此，结论是使用氰基丙烯酸酯组织粘合剂和氨甲环酸可降低拔牙后术后出血事件的发生。尽管壳聚糖牙用敷料和胶原蛋白达到止血的时间更快，但它们导致出血事件的发生几率更高。
