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Editor's Correspondence
November 10, 2003

Oral Anticoagulant and Dental Procedures

Arch Intern Med. 2003;163(20):2532. doi:10.1001/archinte.163.20.2532-a

In an otherwise comprehensive review by Dunn and Turpie1 regarding perioperative management of anticoagulated patients, the role of tranexamic acid mouthwash for patients undergoing dental procedures was not addressed. Notwithstanding our concurring with the authors' statement that many dental procedures can be undertaken without alteration of standard oral anticoagulant regimen, additional benefit of simple local hemostatic measures, as exemplified by tranexamic acid mouthwash, should be appraised. The antifibrinolytic action of tranexamic acid lies in its reversible binding to plasminogen. Whereas oral mucosa and saliva are rich in plasminogen activators, local administration of the drug blocks the binding of plasminogen to fibrin and its activation and transformation to plasmin. Tranexamic acid had been proven to attenuate the bleeding risk among patients undergoing oral surgery in 2 well-conducted prospective randomized trials.2,3 Based on the foregoing evidence, it is therefore recommended that for patients undergoing dental procedures, tranexamic acid mouthwash can be applied without interrupting oral anticoagulant therapy,4 as endorsed by the British Committee for Standards in Haematology,5 American Heart Association, and American College of Cardiology.6

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