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