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Carter GC, Goss A et al. J Oral Maxillofac Surg 2003; 61: 1432–1435

In 49 patients on warfarin anticoagulation, 152 extractions were performed. No adjustment was made to the regime and all patients had INR in the range 2.0–4.0. Although patients who had taken aspirin (which increases INR) were excluded, paracetamol (which also may increase INR) was given as an analgesic. Patients were randomized to tranexamic acid (TA: 71 extractions in 26 subjects) application and mouthwashes, or to application of prepared autologous fibrin glue (AFG: 81 in 23). All sockets were sutured.

In the TA group, 33 extractions were for periodontal disease and 38 for caries; respective figures for AFG were 27 and 54. In each of 2 AFG patients who had multiple extractions, one socket gave minor bleeding, after 3 dys in one case and 7 in the other. At presentation, their INRs were 5.9 and 7.6. The authors comment that tranexamic acid is preferable on grounds of low cost unless patient compliance is an issue.