Interventions for treating post‐extraction bleeding

Sumanth Kumbargere Nagraj; Eachempati Prashanti; Himanshi Aggarwal; Ashok Lingappa; Murugan S Muthu; Salian Kiran Kumar Krishanappa; Haszelini Hassan

doi:10.1002/14651858.CD011930.pub3

拔牙后出血的干预措施

Contraer todo Desplegar todo

Referencias

References to studies excluded from this review

Ir a:

otras referencias
otras versiones publicadas

Ak G, Alpkılıç Başkırt E, Kürklü E, Koray M, Tanyeri H, Zülfikar B. The evaluation of fibrin sealants and tissue adhesives in oral surgery among patients with bleeding disorders. Turkish Journal of Hematology 2012;29(1):40‐7.

Al‐Mubarak S, Rass MA, Alsuwyed A, Alabdulaaly A, Ciancio S. Thromboembolic risk and bleeding in patients maintaining or stopping oral anticoagulant therapy during dental extraction. Journal of Thrombosis and Haemostasis 2006;4(3):689‐91.

Carter G, Goss A, Lloyd J, Tocchetti R. Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study. Journal of Oral and Maxillofacial Surgery 2003;61(12):1432‐5.

CTRI/2017/09/009784. Effectiveness of topical haemocoagulase as a haemostatic agent in children undergoing extraction of deciduous teeth – a split‐mouth, randomized, double‐blind, clinical trial. www.ctri.nic.in (first received 15 September 2017).

Henderson NJ, Crawford PJ, Reeves BC. A randomised trial of calcium alginate swabs to control blood loss in 3‐5‐year‐old children. British Dental Journal 1998;184(4):187‐90.

Howard D, Whitehurst VE, Bingham R, Stanback J. The use of bucrylate to achieve hemostasis in tooth extraction sites. Oral Surgery 1973;35(6):762‐5.

Kjellman O. Apernyl as alveolar inlay in connection with the removal of impacted third molars of the lower jaw. A clinical double blind investigation of 100 patients. Swedish Dental Journal 1973;66(2):197‐200.

Medeiros FB, de Andrade AC, Angelis GA, Conrado VC, Timerman L, Farsky P, et al. Bleeding evaluation during single tooth extraction in patients with coronary artery disease and acetylsalicylic acid therapy suspension: a prospective, double‐blinded, and randomized study. Journal of Oral and Maxillofacial Surgery 2011;69(12):2949‐55.

NCT02918045. Dental extractions in patients under dual antiplatelet therapy (DUALex). clinicaltrials.gov/ct2/show/NCT02918045 (first received 28 September 2016).

NCT03108365. Evaluating the effectiveness of axiostat hemostatic dressing material versus conventional method of hemostasis and healing of extraction wounds in patients on oral anti‐platelet drugs ‐ a comparative study. clinicaltrials.gov/show/NCT03108365 (first received 11 April 2017).

Pinsent RJ, Baker GP, Ives G, Davey RW, Jonas S. Does arnica reduce pain and bleeding after dental extraction?. British Homeopathic Research Group Communications 1986;15:3‐11.

Google Scholar

Zhou RJ. 1985 Aug 5 ( 8) 483‐484. Prevention and treatment of hemorrhage after extraction of teeth by using the pulvis of cibotium barometz‐alum burn. Zhong xi yi jie he za zhi [Chinese Journal of Modern Developments in Traditional Medicine] 1985;5(8):483‐4.

Additional references

Ir a:

estudios excluidos
otras versiones publicadas

Abdullah WA, Khalil H. Dental extraction in patients on warfarin treatment. Journal of Clinical, Cosmetic and Investigational Dentistry 2014;6:65‐9.

Google Scholar

Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasis‐altering medications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2007;103 Suppl:S45 e1‐11.

Al‐Bahlani S, Sherriff A, Crawford PJ. Tooth extraction, bleeding and pain control. Journal of the Royal College of Surgeons of Edinburgh 2001;46(5):261‐4.

Al‐Belasy FA, Amer MZ. Hemostatic effect of n‐Butyl‐2‐Cyanoacrylate (Histoacryl) glue in warfarin‐treated patients undergoing oral surgery. Journal of Oral and Maxillofacial Surgery 2003;61:1405‐9.

Amer MZ, Mourad SI, Salem AS, Abdelfadil E. Correlation between International Normalized Ratio values and sufficiency of two different local hemostatic measures in anticoagulated patients. European Journal of Dentistry 2014;8:475‐80.

Anderson JAM, Brewer A, Creagh D, Hook S, Mainwaring J, McKernan A, et al. Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. British Dental Journal 2013;215:497‐504.

Antoszewski Z. Cepevit‐K preparation in controlling hemorrhages and bleeding following tooth extraction. Polski tygodnik lekarski 1972;27(47):1861‐62.

Auluck A, Pai KM, Bhat KS, Thoppil PS. Unusual post‐extraction hemorrhage in a cardiac patient: a case report. Journal of the Canadian Dental Association 2004;70(11):769‐73.

Bajkin BV, Selaković SD, Mirković SM, Šarčev IN, Tadič AJ, Milekič BR. Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions. Vojnosanitetski pregled 2014;71(12):1097‐101.

Baumann P, Schumacher H, Hüsing J, Luntz S, Knaebel HP. A randomized, controlled, prospective trial to evaluate the haemostatic effect of Lyostypt versus Surgicel in arterial bypass anastomosis: "COBBANA" trial. Trials 2009;10:91.

Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surgery, Oral Medicine, and Oral Pathology 1993;76(4):412‐20.

Cocero N, Pucci F, Messina M, Pollio B, Mozzati M, Bergamasco L. Autologous plasma rich in growth factors in the prevention of severe bleeding after teeth extractions in patients with bleeding disorders: a controlled comparison with fibrin glue. Blood Transfusion 2015;13(2):287‐94.

Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Ermer M. Post‐operative bleeding in dento‐alveolar surgery. Available from http://www.drks.de/DRKS00009286 (accessed 31 March 2016).

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. British Medical Journal 1997;315(7109):629‐34.

Fetkowska‐Mielnik K, Komorowska A. Clinical evaluation of the results of treatment of postextraction bleeding with new drugs E.A.C.A., styptanon. Czasopismo stomatologiczne 1969;22(2):179‐83.

Funayama M, Kumagai T, Saito K, Watanabe T. Asphyxial death caused by postextraction hematoma. American Journal of Forensic Medicine and Pathology 1994;15:87–90.

Glick JB, Kaur RR, Siegel D. Achieving hemostasis in dermatology‐Part II: Topical hemostatic agents. Indian Dermatology Online Journal 2013;4(3):172‐6.

GRADE Working Group, McMaster University. GRADEpro GDT. Version accessed 22 March 2016. Hamilton (ON): GRADE Working Group, McMaster University, 2014.

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [March 2011], The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Higginson I. Post Extraction Dental Haemorrhage. EMed Handbook ‐ Cork Emergency Medicine, Available from http://www.emed.ie/HE‐ENT/Dental/Dental_Haemorrhage_Post_Extraction.php#typ (accessed 16 March 2016).

Howe N, Cherpelis B. Obtaining rapid and effective hemostasis: Part I. Update and review of topical hemostatic agents. Journal of the American Academy of Dermatology 2013;69(5):659.e1‐17.

Iwabuchi H, Imai Y, Asanami S, Shirakawa M, Yamane GY, Ogiuchi H, et al. Evaluation of postextraction bleeding incidence to compare patients receiving and not receiving warfarin therapy: a cross‐sectional, multicentre, observational study. BMJ Open 2014;4(12):e005777.

Jensen S. Hemorrhage after oral surgery. An analysis of 103 cases. Oral Surgery, Oral Medicine, and Oral Pathology 1974;37(1):2‐16.

Joshi SA, Gadre KS, Halli R, Shandilya R. Topical use of Hemocoagulase (Reptilase): a simple and effective way of managing post‐extraction bleeding. Annals of Maxillofacial Surgery 2014;4(1):119.

Kataoka T, Hoshi K, Ando T. Is the HAS‐BLED score useful in predicting post‐extraction bleeding in patients taking warfarin? A retrospective cohort study. BMJ Open 2016;6(3):e010471. [DOI: 10.1136/bmjopen‐2015‐010471]

Khomiachenko VP. Use of aminocaproic acid for stopping the hemorrhage after tooth extraction. Stomatologiia (Mosk) 1978;57(1):91.

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.

Leonard MS. An approach to some dilemmas and complications of office oral surgery. Australian Dental Journal 1993;40(3):159‐63.

Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease. British Dental Journal 2003;195(8):439‐45.

Malik NA. Textbook of Oral and Maxillofacial Surgery. Second Edition. New Delhi: Jaypee Brothers Medical Publishers, 2008.

Marini MP, Arturi F, Crolle G. Therapy of post‐extraction hemorrhages in hemophiliac patients with epsilon‐aminocaproic acid (EACA). Haematologica 1966;51(7):553‐68.

Martineau C. Hemorrhage in the dental office. Study of local hemostatic treatment. Information dentaire 1989;71(40):3861‐69.

McCormick NJ, Moore UJ, Meechan JG, Norouzi M. Haemostasis. Part 2: Medications that affect haemostasis. Dental Update 2014;41(5):395‐405.

McCormick NJ, Moore UJ, Meechan JG. Haemostasis. Part 1: The management of post‐extraction haemorrhage. Dental Update 2014;41(4):290‐2, 294‐6.

McDonnell D. Bleeding sockets. British Dental Journal 2013;215:104.

Mingarro‐de‐León A, Chaveli‐López B, Gavaldá‐Esteve C. Dental management of patients receiving anticoagulant and/or antiplatelet treatment. Journal of Clinical and Experimental Dentistry 2014;6(2):e155‐61.

Minkin P, Bertetti R, Lindsey S, Bovino B. Management of tooth extraction in a patient with a rare bleeding disorder associated with Hermansky‐Pudlak syndrome: a case report. Journal of Oral and Maxillofacial Surgery 2015;73(2):219‐23.

Morimoto Y, Yoshioka A, Imai Y, Takahashi Y, Minowa H, Kirita T. Haemostatic management of intraoral bleeding in patients with congenital deficiency of alpha2‐plasmin inhibitor or plasminogen activator inhibitor‐1. Haemophilia 2004;10(5):669‐74.

Neuner O, Schegg HK. Therapy of hemorrhage following extractions. Schweizerische Monatsschrift fur Zahnheilkunde 1968;78(10):974‐82.

Pavek V. Evaluation of the hemostatic effect of Dicynon in dentoalveolar surgery. Ceskoslovenska stomatologie 1976;76(1):56‐64.

Perdigão JP, de Almeida PC, Rocha TD, Mota MR, Soares EC, Alves AP, et al. Postoperative bleeding after dental extraction in liver pretransplant patients. Journal of Oral and Maxillofacial Surgery 2012;70:e177‐84.

Pippi R, Santoro M, Cafolla A. The effectiveness of a new method using an extra‐alveolar hemostatic agent after dental extractions in older patients on oral anticoagulation treatment: an intrapatient study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 2015 [Epub ahead of print];120(1):15‐21. [DOI: 10.1016/j.oooo.2015.02.482]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Rokicka‐Milewska R, Krajewska‐Martel A, Dyszy‐Laube B. Application of epsilon‐aminocaproic acid for oral mucosal bleeding in hemophiliacs. Polskie Archiwum Medycyny Wewnetrznej 1966;37(4):445‐50.

Saltykova ZA, Tarasova LN. The use of new hemostatic drug in dental practice. Stomatologiia 1974;53(1):85‐6.

Scarano A, Sinjari B, Murmura G, Mijiritsky E, Iaculli F, Mortellaro C, et al. Hemostasis control in dental extractions in patients receiving oral anticoagulant therapy: an approach with calcium sulfate. Journal of Craniofacial Surgery 2014;25(3):843‐6.

Sharma S, Kale TP, Balihallimath LJ, Motimath A. Evaluating effectiveness of axiostat hemostatic material in achieving hemostasis and healing of extraction wounds in patients on oral antiplatelet drugs. Journal of Contemporary Dental Practice 2017;18(9):802‐6. [PUBMED: 28874645]

Soltani R, Haghighat A, Fanaei M, Asghari G. Evaluation of the effect of green tea extract on the prevention of gingival bleeding after posterior mandibular teeth extraction: a randomized controlled trial. Evidence‐Based Complementary and Alternative Medicine2014; Vol. 2014, issue article 857651. [DOI: 10.1155/2014/857651]

Google Scholar

Stanca CM, Montazem AH, Lawal A, Zhang JX, Schiano TD. Intranasal eesmopressin versus blood transfusion in cirrhotic patients with coagulopathy undergoing dental extraction: a randomized controlled trial. Journal of Oral and Maxillofacial Surgery 2010;68:138‐43.

Szpirglas H, Gotte P, Tsamis J, Fraccari F. Stomatological hemorrhages; hemostasis with GRF (gelatin‐resorcin‐formol). Minerva stomatologica 1979;28(4):285‐7.

Torteli A, Hattyasy D. Use of "reptilase" in postoperative hemorrhages of the dental apparatus. Schweizerische Monatsschrift fur Zahnheilkunde 1965;75(11):1214‐21.

Traver MA, Assimos DG. New generation tissue sealants and hemostatic agents: innovative urologic applications. Reviews in Urology 2006;8(3):104‐11.

Trentalancia M. The use of 5‐oxytryptamine in post‐extraction hemorrhages. Dental Cadmos 1967;35(10):1377‐90.

University of Cambridge University Dental Practice. Persistent bleeding following dental extraction. Available from http://www.dental.cam.ac.uk/info‐nhs/dis‐post‐extraction‐bleeding. (accessed on 16 March 2016).

Van Galen KPM, Engelen ET, Mauser‐Bunschoten EP, Van Es RJJ, Schutgens REG. Antifibrinolytic therapy for preventing oral bleeding in patients with a hemophilia or Von Willebrand disease undergoing oral or dental procedures. Cochrane Database of Systematic Reviews 2014, Issue 12. [DOI: 10.1002/14651858.CD011385]

Wahl MJ, Schmitt MM. Postextraction bleeding in a patient taking antithrombotics: report of a case. General Dentistry 2016;64(3):60‐3. [PUBMED: 27148659]

Wells D, Capes J, Powers M. Complications of dentoalveolar surgery. In: Fonseca R editor(s). Oral and Maxillofacial Surgery. Vol. 1, Philadelphia: WB Saunders, 2000:421‐38.

Google Scholar

Worthington H, Clarkson J, Weldon J. Priority oral health research identification for clinical decision‐making. Evidence‐based Dentistry 2015;16(3):69‐71.

Yagyuu T, Kawakami M, Ueyama Y, Imada M, Kurihara M, Matsusue Y, et al. Risks of postextraction bleeding after receiving direct oral anticoagulants or warfarin: a retrospective cohort study. BMJ Open 2017;7:e015952. [DOI: 10.1136/bmjopen‐2017‐015952]

References to other published versions of this review

Ir a:

estudios excluidos
otras referencias

Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Kiran Kumar Krishanappa S. Interventions for managing post‐extraction bleeding. Cochrane Database of Systematic Reviews 2015, Issue 10. [DOI: 10.1002/14651858.CD011930]

Kumbargere Nagraj S, Prashanti E, Aggarwal H, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S, et al. Interventions for treating post‐extraction bleeding. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD011930.pub2]

Google Scholar

Characteristics of studies

Characteristics of excluded studies [ordered by study ID]

Study	Reason for exclusion
Ak 2012	Preventive trial
Al‐Mubarak 2006	Preventive trial
Carter 2003	Preventive trial
CTRI/2017/09/009784	Trial for management of bleeding immediately after deciduous teeth extraction
Henderson 1998	Preventive trial
Howard 1973	Preventive trial
Kjellman 1973	Trial for pain management after removal of impacted third molar
Medeiros 2011	No treatment. It measured the amount of intraoperative and postoperative bleeding during and after the suspension of aspirin
NCT02918045	Preventive trial
NCT03108365	Preventive trial
Pinsent 1986	Preventive trial
Zhou 1985	Preventive trial

Figure 1

Different phases of coagulation

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Study flow diagram

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Summary of findings for interventions to treat post‐extraction bleeding

Interventions for treating post‐extraction bleeding
Patient or population: people with post‐extraction bleeding Settings: hospital or dental practice
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
Bleeding, as measured by: amount of blood loss; complete cessation of bleeding, as assessed clinically by the investigator; time required for the control of bleeding.	No data are available as no RCTs have been conducted on interventions to treat post‐extraction bleeding
Patient‐reported outcomes related to pain or discomfort during the procedure
Treatment‐associated average cost
Adverse events
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings for the main comparison. Summary of findings for interventions to treat post‐extraction bleeding

Ir a la tabla de la revisión

Table 1. Types of bleeding after dental extractions

Normal bleeding

Post‐extraction bleeding

Primary

Reactionary

Secondary

Normally persists for up to half an hour
Oozing and blood tinged saliva for up to 8 hours
Controlled by pressure pack

Occurs during and immediately after extraction
Typically presents as blood filling up the mouth
Usually due to infection or trauma to blood vessels
Often controlled by local techniques like pressure packs, haemostatic agents, etc

Begins two to three hours post extraction, after the vasoconstrictor effect of local anaesthesia wears off
Usually due to underlying systemic conditions such as bleeding or clotting disorders
Not controlled by local measures and may require systemic interventions

Usually begins 7 to 10 days post extraction
Mainly due to secondary infection
Rare in dental extractions, compared to the other two types of post‐extraction bleeding

Table 1. Types of bleeding after dental extractions

Ir a la tabla de la revisión

Table 2. Summarising the risk of bias for a body of evidence

Risk of bias	Interpretation	In outcome	In included studies
Low risk of bias	Plausible bias unlikely to seriously alter the results	Low risk of bias for all key domains	Most information is from studies at low risk of bias
Unclear risk of bias	Plausible bias that raises some doubt about the results	Unclear risk of bias for one or more key domains	Most information is from studies at low or unclear risk of bias
High risk of bias	Plausible bias that seriously weakens confidence in the results	High risk of bias for one or more key domains	The proportion of information from studies at high risk of bias is sufficient to affect the interpretation of results

Table 2. Summarising the risk of bias for a body of evidence

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

References to studies excluded from this review

Ak 2012 {published data only}

Al‐Mubarak 2006 {published data only}

Carter 2003 {published data only}

CTRI/2017/09/009784 {unpublished data only}

Henderson 1998 {published data only}

Howard 1973 {published data only}

Kjellman 1973 {published data only}

Medeiros 2011 {published data only}

NCT02918045 {published data only}

NCT03108365 {published data only}

Pinsent 1986 {published data only}

Zhou 1985 {published data only}

Additional references

Abdullah 2014

Aframian 2007

Al‐Bahlani 2001

Al‐Belasy 2003

Amer 2014

Anderson 2013

Antoszewski 1972

Auluck 2004

Bajkin 2014

Baumann 2009

Chiapasco 1993

Cocero 2015

Deeks 2011

DRKS00009286

Egger 1997

Fetkowska‐Mielnik 1969

Funayama 1994

Glick 2013

GRADEpro GDT 2014 [Computer program]

Higgins 2011

Higginson 2007

Howe 2013

Iwabuchi 2014

Jensen 1974

Joshi 2014

Kataoka 2016

Khomiachenko 1978

Lefebvre 2011

Leonard 1995

Lockhart 2003

Malik 2008

Marini 1966

Martineau 1989

McCormick 2014a

McCormick 2014b

McDonnell 2013

Mingarro‐de‐León A 2014

Minkin 2015

Morimoto 2004

Neuner 1968

Pavek 1976

Perdigão 2012

Pippi 2015

RevMan 2014 [Computer program]

Rokicka‐Milewska 1966

Saltykova 1974

Scarano 2014

Sharma 2017

Soltani 2014

Stanca 2010

Szpirglas 1979

Torteli 1965

Traver 2006

Trentalancia 1967

University of Cambridge

Van Galen 2014

Wahl 2016

Wells 2000

Worthington 2015

Yagyuu 2017

References to other published versions of this review

Sumanth 2015

Sumanth 2016