Haemostatic measures

For all patients taking anticoagulants or antiplatelet drugs, haemostasis should be achieved using local measures prior to the patient being discharged from care.

Serious consideration should be given to suturing and packing, taking into account all relevant patient factors, such as

  • the drug or drug combination that the patient is taking
  • other medical conditions or medication that may impact on bleeding
  • the travel time for the patient to access emergency care if required

Failure of initial haemostasis will necessitate packing and suturing at a later time.

Patients taking aspirin alone are unlikely to have a higher risk of post-operative bleeding complications than non-anticoagulated patients and may not require suturing.

The dental practitioner should have available*:

  • Absorbent gauze
  • Haemostatic packing material (e.g. oxidized cellulose, collagen sponge)
  • Suture kit (needle holders, tissue forceps, suture material, scissors)

*Some of these materials contain animal-based protein which may not be acceptable to all patients, for ethical, cultural or religious reasons. Practices should ensure that non-animal-based products are also available and establish patient preferences before treatment.

Some guidelines recommend the use of tranexamic acid mouthwash as an additional haemostatic measure. While there is evidence that tranexamic acid reduces the bleeding risk from dental treatment in patients on antithrombotic therapies when compared to placebo, it may not have significant benefit when compared to other haemostatic measures.

Tranexamic acid is not included in the List of Dental Preparations in the British National Formulary (BNF) and therefore cannot be prescribed on the NHS. In addition, tranexamic acid is not available as a mouthwash so has to be prepared and prescribed 'off label'. 

Based on these considerations, this guidance does not advise primary care practitioners to prescribe tranexamic acid for dental procedures. However, if tranexamic acid is prescribed by the patient’s medical practitioner then it should be used in addition to local measures.