The influence of anticoagulants on bleeding and healing after dental extraction

The current PhD project is about patients on antithrombotic medication undergoing dental extractions and focusses on two genuine concerns. First, oral bleeding after dental extraction in patients on non-vitamin K oral anticoagulants is a frequent problem, and it is not sure how to reduce the risk of bleeding. A placebo-controlled, double blind, randomized clinical trial was set up to evaluate if the use of tranexamic acid mouthwash, an antifibrinolytic agent, after dental extraction reduces bleeding in this patient population. The results indicated that tranexamic acid mouthwash does not reduce peri-operative bleeding or early bleeding (until one day) after dental extraction, but may reduce delayed bleeding (more than one day after) and bleeding in case multiple teeth are extracted. Second, variation of leukocyte- and platelet-rich fibrin (L-PRF) membranes was noticed in the clinical practice and antithrombotic medication may be one of the causing factors as they interfere with blood coagulation, a process that is crucial for the generation of L-PRF. L-PRF membranes consist of a fibrin network entrapping platelet concentrated and immune cells. As L-PRF membranes are used to guide healing and enhance tissue regeneration and as hemostatic method with oral surgery, the variability amongst the membranes may have clinical implications. Therefore, two experiments were set up to compare properties of L-PRF membranes between patients taking antithrombotics and controls. It was shown that L-PRF membranes of patients on an anticoagulant therapy, but not on antiplatelets, are weaker, rupture faster and contain less leukocytes than membranes of patients not taking antithrombotic drugs. The outcomes of this thesis could allow a better post-extraction management of patients on non-vitamin K oral anticoagulants and an optimization of the leukocyte- and platelet-rich fibrin healing technique.

Jaar van publicatie:2021

Toegankelijkheid:Open