EFFICACY AND SAFETY OF TRANEXAMIC ACID IN REDUCING HEMORRHAGE DURING ORAL SURGERY: A SYSTEMATIC REVIEW

Abstract

Background: Postoperative hemorrhage remains a significant concern in oral surgery, particularly among patients on anticoagulant therapy or undergoing complex dental extractions. Tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a promising hemostatic agent, but its efficacy and safety in oral surgery require further evaluation. Objective: This systematic review assesses the efficacy and safety of TXA in reducing hemorrhage during oral surgical procedures.

Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Web of Science, Scopus, and Cochrane Library. Randomized controlled trials (RCTs) and observational studies evaluating TXA in oral surgery were included. Data on bleeding incidence, thromboembolic events, and adverse effects were extracted and synthesized. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale.

Results: Six studies (n=416 patients) met inclusion criteria. TXA significantly reduced postoperative bleeding in anticoagulated patients (RR 0.49, p=0.046) compared to collagen-gelatin sponges. A 10% TXA mouthwash reduced delayed bleeding (RR 0.32) but showed no significant effect on early bleeding (p=0.72). Novel formulations, such as chitosan/propolis/TXA gingival retraction cords, demonstrated rapid hemostasis (456 s coagulation time) and antibacterial effects. No thromboembolic events were reported with TXA use.

Conclusion: TXA is an effective and safe hemostatic agent in oral surgery, particularly for high-risk patients and delayed bleeding prevention. Optimal dosing and delivery methods require further standardization. Future research should focus on large-scale RCTs to refine clinical protocols.