The role of hemostatic agents following dental extractions: a systematic review and meta-analysis

Objective: This study critically evaluated the role of hemostatic agents
following dental extractions, and the benefits they add over conventional
hemostatic measures. Materials and methods: a literature search was
conducted, including publications that fulfilled the criteria developed
based on the PICOS guidelines; Population: patients who receive simple or
surgical tooth extractions, Intervention: the use of hemostatic agents
following dental extraction, Control: any type of conventional hemostatic
measures (i.e. suture, gauze pressure), Outcome: time to achieve
hemostasis following tooth removal, postoperative pain, swelling, or
bleeding events, and Study design: randomized/controlled clinical trials.
Results: Twenty-eight articles met the inclusion criteria, and 24 were
meta-analyzed. Several types of hemostatic agents were used, namely tissue
adhesives made from cyanoacrylate or fibrin, tranexamic acid,
hemocoagulase, collagen membrane, HemCon dental dressing, epsilon
aminocaproic acid, Surgicel, sponges or plugs composed of gelatin,
oxidized cellulose, and fibrin. Newer hemostatic agents were also applied,
such as Ankaferd blood stopper, and feracrylum. Hemostatic agents
demonstrated significantly shorter time to achieve hemostasis and fewer
bleeding events in patients on antithrombotic drugs or with bleeding
disorders (WMD= -2.12, 95% CI -2.63 to -1.61, P < 0.00001, and RR
0.61, 95% CI 0.43 to 0.86; P= 0.005, respectively). Furthermore, the use
of these agents resulted in significantly less postoperative pain
following 3rd molar surgery in healthy patients (WMD= -0.33, 95% CI -0.65
to -0.02, P = 0.04). Conversely, they did not have any effect on
postoperative swelling (WMD= -0.11, 95% CI -0.31 to 0.08, P = 0.26). The
time needed to finish the surgical procedure when hemostatic agents were
used was shorter but with no significant difference (MD= -78.93, 95% CI
-187.35 to 29.49, P = 0.15). Conclusion: Included studies differ in their
methods of reporting bleeding, pain, and swelling. Thus, the results of
this article should be confirmed in future research. Within these
limitations, it is concluded that hemostatic agents lead to faster
hemostasis and fewer postoperative bleeding incidences, compared to
conventional hemostatic measures. Their use is highly recommended
following dental extractions in patients on antithrombotic drugs or with
bleeding disorders, who are likely to develop postoperative hemorrhage
events.