Efficacy of Local Hemostatic Management in Implant Surgery in Anticoagulated Patients on Warfarin: A Randomized Clinical Study

Purpose: To compare the frequency of immediate/short-term postoperative bleeding and occurrence of hematomas using tranexamic acid (TXA), bismuth subgallate (BS), or dry gauze (DG) as a local hemostatic agent, and to explore the relation between short-term bleeding and occurrence of intraoral and extraoral hematomas and length of incision, duration of surgery, and alveolar ridge recontouring in patients who were continued on oral anticoagulation therapy.
Materials and Methods: Eighty surgical procedures performed in 71 patients were assigned to one of four groups (20 each): control group (patients not on oral anticoagulant therapy) and three experimental groups (patients on oral anticoagulation therapy managed with local hemostatic measures): TXAg, BSg, or DGg. Studied variables were length of incision, duration of surgery, and alveolar ridge recontouring. Short-term bleeding episodes and occurrence of intraoral and extraoral hematomas were recorded.
Results: A total of 111 implants were placed. No significant differences in mean international normalized ratio, duration of surgery, and length of incision were observed among groups (P > .05). Short-term bleeding and intraoral and extraoral hematomas were observed in 2, 2, and 14 surgical procedures, respectively, and did not differ significantly among groups. Overall relation between variables showed no association between extraoral hematomas and duration of surgery/length of incision (P > .05). Association between extraoral hematomas and alveolar ridge recontouring was statistically significant (OR = 26.72). Association with short-term bleeding and intraoral hematomas was not studied due to the small number of events.
Conclusion: Implant placement in warfarin anticoagulated patients without withdrawing oral anticoagulation therapy is a safe and predictable procedure, and different local hemostatic agents (TXA, BS, and DG) are effective in managing postoperative bleeding. Development of hematomas may be higher in patients undergoing alveolar ridge recontouring. Further studies are necessary to confirm these results.