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Wednesday, March 18, 2015

Benefits of Tranexamic Acid mouthwash

  • Tranexamic acid is an antifibrinolytic agent that inhibits the breakdown of fibrin clots. Its primary action is to block the binding of plasminogen and plasmin to fibrin therefore preventing fibrinolysis.
  •  It has been used in anticoagulated dental patients as a local haemostatic agent in the form of a mouthwash

SUMMARY OF EVIDENCE
  • When used alone with no local haemostatic dressing, tranexamic acid mouthwash reduces postoperative bleeding compared to placebo mouthwash.
  • When used in combination with local haemostatic measures and suturing, tranexamic acid mouthwash provides little additional reduction in postoperative bleeding.

PRACTICAL ISSUES
  • No tranexamic acid mouthwash available commercially
  • The agents used in the study are either 4.8% tranexamic acid mouthwash or a tranexamic acid 500mg in a mouthwash
  • No specific guides or recommendations on the administration. Based on practice and papers:
  • 4.8% tranexamic acid mouthwash: rinse with 10ml for 2 minutes and expectorate, four times a day for 7 days
  • Tranexamic acid 500mg in a mouthwash: used for 2 minutes, four times a day

MANUFACTURING
  • The mouthwash is commonly made based on formula using IV tranexamic acid
  • However, some practice do recommend the administration of oral 500mg Tranexamic acid dispersed into 10-15ml of water.

REFERENCES:
  1. SURGICAL MANAGEMENT OF THE PRIMARY CARE DENTAL PATIENT ON WARFARIN. http://www.app.dundee.ac.uk/tuith/Static/info/warfarin.pdf
  2. Preparing tranexamic acid 4.8% mouthwash. http://www.australianprescriber.com/magazine/26/4/75/7
  3. Management of patients taking warfarin who require minor oral surgery. https://www.tg.org.au/etg_demo/phone/etg_dtg2_warfarin-and-minor-surgery.pdf

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