Topical Tranexamic Acid vs. Collagen-Gelatin Sponge for Bleeding Control

A new study published in the Journal of Cranio-Maxillofacial Surgery suggests that topical tranexamic acid (TXA) is better than a collagen-gelatin sponge for bleeding control after tooth extraction in patients on anticoagulants.

This two-arm, parallel-group, double-blind, randomized clinical trial design evaluated the risk of postoperative bleeding in anticoagulated patients undergoing dental extraction treated with topical TXA in comparison to a collagen-gelatin sponge. Forty patients were randomly included in one of the study groups:

• Topical use of 4.8% TXA solution
• Resorbable hydrolyzed collagen-gelatin sponge applied to the surgical alveolus

Primary outcomes were postoperative bleeding episodes and secondary outcomes were thromboembolic events and postoperative INR values. The relative risk (RR), the absolute risk reduction (RAR), and the number needed to treat (NNT) were used as effect estimates and calculated from the counting of bleeding episodes observed during the first postoperative week.

The bleeding rate under the TXA treatment was 22.2%, while in the collagen-gelatin sponge group it was 45.7%, resulting in a RR of 0.49 (95% CI 0.24–0.99; p = 0.046), RAR 23.5%, and NNT 4.3. TXA was more effective in reducing bleeding in surgical sites located in the mandible (RR = 0.10; 95% CI 0.01–0.71; p = 0.021) and the posterior region (RR = 0.39; 95% CI 0.18–0.84; p = 0.016).

Within the study's limitations, it seems that topical TXA is more effective in controlling bleeding after tooth extractions in anticoagulated patients than a collagen-gelatin sponge.

Reference

Sara Juliana de Abreu de Vasconcellos, Raquel Souza dos Santos Marques, Elisama Gomes Magalhães de Melo, Camila Silva de Almeida, João Victor de Almeida Góes Silva, Liane Maciel de Almeida Souza, Paulo Ricardo Martins-Filho. Risk of bleeding in anticoagulated patients undergoing dental extraction treated with topical tranexamic acid compared to collagen-gelatin sponge: Randomized clinical trial, Journal of Cranio-Maxillofacial Surgery, Volume 51, Issue 6, 2023, Pages 393-398, ISSN 1010-5182, https://doi.org/10.1016/j.jcms.2023.06.003.

Read the full article

Keywords

• Journal of Cranio-Maxillofacial Surgery
• Tranexamic acid
• Oral surgery
• Bleeding
• Sara Juliana de Abreu de Vasconcellos
• Raquel Souza dos Santos Marques
• Elisama Gomes Magalhães de Melo
• Camila Silva de Almeida
• João Victor de Almeida Góes Silva
• Liane Maciel de Almeida Souza
• Paulo Ricardo Martins-Filho