From the Guidelines
Tranexamic acid is the recommended medication for managing dental bleeding, as it can be used to inhibit fibrinolysis and allow clots to form and remain stable at the bleeding site. This is based on the most recent and highest quality study available, which suggests that continuing VKAs with a prohemostatic agent, such as tranexamic acid, is associated with a low risk for clinically relevant nonmajor bleeding 1.
Key Points to Consider
- Tranexamic acid can be used as a mouthwash solution or taken orally to manage dental bleeding, with a recommended dose of 500 mg tablets three times daily for 3-5 days 1.
- For patients on anticoagulants, tranexamic acid is particularly effective and generally doesn't require discontinuation of their regular medication 1.
- In cases where tranexamic acid isn't available, aminocaproic acid can serve as an alternative 1.
- Patients should avoid hot foods, alcohol, smoking, and vigorous rinsing for 24 hours after dental procedures to prevent dislodging blood clots.
- If bleeding persists despite these measures, professional dental care should be sought promptly.
Management Strategies
- Continuing VKAs with a prohemostatic agent, such as tranexamic acid, is a recommended approach for managing dental bleeding in patients on anticoagulants 1.
- Partial interruption of VKA therapy for 2 to 3 days before a dental procedure may also be considered, but this approach may be associated with a higher risk of bleeding 1.
- Complete VKA interruption is not generally recommended, as it may increase the risk of thromboembolic events 1.
From the FDA Drug Label
Tranexamic acid is an antifibrinolytic indicated in patients with hemophilia for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction.
DOSAGE AND ADMINISTRATION • Before Extraction: Administer 10 mg/kg actual body weight of Tranexamic acid injection intravenously with replacement therapy. • After Extraction: Administer 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days.
The recommended medication for managing dental bleeding is tranexamic acid. The dosage is:
- 10 mg/kg actual body weight intravenously before extraction
- 10 mg/kg actual body weight 3 to 4 times daily for 2 to 8 days after extraction 2
From the Research
Dental Bleeding Medication
- Tranexamic acid (TXA) is a recommended medication for managing dental bleeding, as it reduces blood loss by inhibiting the enzymatic breakdown of fibrin 3, 4, 5, 6, 7.
- TXA can be used as a supportive topical application for hemostasis in oral bleeding events, and its use can aid in stopping mild bleeding events such as bloody oozing of an oral wound 4.
- The quality of an oral bleeding episode should be considered in the choice of hemostatic measure, and hemostatic approaches should begin with the least invasive procedure 4.
- TXA has been shown to be effective in reducing bleeding in patients undergoing dental extractions, especially in those with bleeding disorders or taking antithrombotic drugs 6.
- The optimal dose and timing of TXA administration may vary depending on the clinical indication, and there is no consensus about the optimal TXA dose for many indications 6.
- TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery, and an increased mortality after delayed administration of TXA for trauma events or postpartum hemorrhage 6.