Clinical evaluation of topical tranexamic acid in aspirin-treated patients undergoing tooth extraction: bleeding control, healing quality, and postoperative complications

Dental extractions in patients receiving continuous antiplatelet therapy presents a clinical challenge due to the perceived increased risk of postoperative bleeding. Current evidence suggests that interruption of antiplatelet agents may expose patients to serious thromboembolic events without providing significant reduction in bleeding complications. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as a safe and effective local hemostatic measure. However, limited data exist regarding its impact on postoperative bleeding control, wound healing, and infection rates among patients who remain on antiplatelet therapy

This study aimed to evaluate the effectiveness of topical TXA (5%) in controlling bleeding following simple tooth extractions in patients maintained on aspirin therapy, as well as to assess postoperative wound healing, pain incidence, alveolitis occurrence, and local inflammatory reactions.

Twenty patients on continuous aspirin therapy underwent simple dental extractions. A 5% TXA solution was applied locally for 30 minutes immediately after extraction. Bleeding time, postoperative complications, and healing outcomes were recorded over a 7-day follow-up period.

All extractions were completed within an average of 2 minutes and achieved immediate hemostasis without postoperative bleeding. Twelve patients reported mild-to-moderate pain within the first 24 hours. Alveolitis occurred in 3 patients, classified as moderate in severity. Five patients developed localized inflammation, resolving spontaneously within 7 days. No systemic complications or bleedingrelated events were observed.

Local application of 5% TXA is a highly effective hemostatic strategy for simple extractions in patients maintained on antiplatelet therapy. Maintaining aspirin therapy does not increase the risk of postoperative bleeding when TXA is used, and wound healing outcomes remain favorable. TXA may serve as a valuable adjunct in optimizing postoperative recovery and minimizing complications in this patient population.