Authors : Anita Ismaili Bimbashi; Enis Redjep; Gazmend Jusufi; Almir Babacic

Volume/Issue : Volume 11 - 2026, Issue 10 - October

Google Scholar : https://tinyurl.com/88wafr7z

DOI : https://doi.org/10.38124/ijisrt/26Oct1549

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background: Antithrombotic therapy is increasingly common in dental patients and creates a practical need to balance postoperative bleeding against potentially severe thromboembolic events associated with inappropriate medication interruption.  Objective: To critically review perioperative assessment, antithrombotic drug classes, conventional local hemostasis, tranexamic acid, chitosan-based dressings and platelet-rich fibrin (PRF) for simple and surgical extractions.  Review Approach: This expanded narrative review integrates major dental guidance and selected clinical trials and systematic reviews. It is not a systematic review; no exhaustive search, formal risk-of-bias grading or meta-analysis was conducted.  Synthesis: Most low-risk dental extractions can be performed without routine antithrombotic interruption when meticulous local hemostasis is available. Higher-bleeding-risk procedures require drug-specific planning. Tranexamic acid may reduce selected delayed bleeding outcomes; chitosan is promising for rapid local control; PRF offers a biological scaffold with possible healing benefits, although heterogeneous methods limit comparative conclusions.  Conclusion: Risk-stratified treatment, atraumatic surgery, pressure, socket packing, sutures and appropriate follow-up remain the foundation of safe care. Newer agents should be viewed as adjuncts rather than substitutes for clinical judgment.

Keywords : Dental Extraction; Oral Surgery; Anticoagulants; Antiplatelet Drugs; Tranexamic Acid; Chitosan; Platelet-Rich Fibrin; Postoperative Bleeding.

References :

1. American Dental Association. Oral anticoagulant and antiplatelet medications and dental procedures [Internet]. Available from: https://www.ada.org/resources/ada-library/oral-health-topics/oral-anticoagulant-and-antiplatelet-medications-and-dental-procedures
2. Scottish Dental Clinical Effectiveness Programme. Management of dental patients taking anticoagulants or antiplatelet drugs. 2nd ed. Dundee: SDCEP; 2022. Available from: https://www.sdcep.org.uk/published-guidance/anticoagulants-and-antiplatelets/
3. Katz MS, Ooms M, Heitzer M, Steiner T, Bock A, Peters F, et al. Platelet-rich fibrin as a hemostatic agent in dental extractions in patients taking anticoagulants or antiplatelet medication: a systematic review. Clin Oral Investig. 2024;28:587. doi:10.1007/s00784-024-05983-x.
4. Ockerman A, Miclotte I, Vanhaverbeke M, Vanassche T, Belmans A, Vanhove J, et al. Tranexamic acid and bleeding in patients treated with non-vitamin K oral anticoagulants undergoing dental extraction: the EXTRACT-NOAC randomized clinical trial. PLoS Med. 2021;18(5):e1003601. doi:10.1371/journal.pmed.1003601.
5. Mahardawi B, Jiaranuchart S, Rochanavibhata S, Arunjaroensuk S, Mattheos N, Pimkhaokham A. The role of hemostatic agents after tooth extractions: a systematic review and meta-analysis. J Am Dent Assoc. 2023;154(8):742-752.e1. doi:10.1016/j.adaj.2023.05.003.
6. Ockerman A, Miclotte I, Vanhaverbeke M, Verhamme P, Poortmans LL, Vanassche T, et al. Local haemostatic measures after tooth removal in patients on antithrombotic therapy: a systematic review. Clin Oral Investig. 2019;23(4):1695-1708. doi:10.1007/s00784-018-2576-x.
7. Weltman NJ, Al-Attar Y, Cheung J, Duncan DPB, Katchky A, Azarpazhooh A, et al. Management of dental extractions in patients taking warfarin as anticoagulant treatment: a systematic review. J Can Dent Assoc. 2015;81:f20. PMID:26679334.
8. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomized controlled trial. Br J Oral Maxillofac Surg. 2002;40(3):248-252. doi:10.1054/bjom.2001.0773.
9. Boccatonda A, Frisone A, Lorusso F, Bugea C, Di Carmine M, Schiavone C, et al. Perioperative management of antithrombotic therapy in patients who undergo dental procedures: a systematic review of the literature and network meta-analysis. Int J Environ Res Public Health. 2023;20(7):5293. doi:10.3390/ijerph20075293.
10. Jolly SS, Rattan V. Is chitosan-based dressing more effective than gauze pressure in achieving early hemostasis after dental extractions in patients with deranged coagulation profiles? Arch Craniofac Surg. 2025;26(2):65-69. doi:10.7181/acfs.2024.0082.
11. Agrawal D, Zaheer S, Newaskar V. Efficacy of chitosan dressing as a local haemostatic agent in the management of dental extractions in patients on antiplatelet therapy: a prospective randomized study. J Oral Biol Craniofac Res. 2025;15(6):1715-1720. doi:10.1016/j.jobcr.2025.10.012.
12. Queiroz SIML, Silvestre VD, Soares RM, Campos GBP, Germano AR, da Silva JSP. Tranexamic acid as a local hemostasis method after dental extraction in patients on warfarin: a randomized controlled clinical study. Clin Oral Investig. 2018;22(6):2281-2289. doi:10.1007/s00784-017-2327-4.