Topical tranexamic acid powder for bleeding control in dentistry: a scoping review

Bergo, Beatriz Rezende; Nunes, Letícia Mendes; Andrade, Camila Vassallo de; Costa, Paula Cristina; Jardilino, Francisca Daniele Moreira; Rocha, Amanda Leal

doi:10.31744/einstein_journal/2026RW1859

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Review • einstein (São Paulo) 24 • 2026 • https://doi.org/10.31744/einstein_journal/2026RW1859 linkcopy

Topical tranexamic acid powder for bleeding control in dentistry: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: This scoping review evaluated the efficacy of topical tranexamic acid powder, prepared from crushed tablets, for bleeding prevention during minor oral surgical procedures.

Methods: A comprehensive literature search was conducted in accordance with PRISMA-ScR guidelines across MEDLINE/PubMed, Elsevier, Embase, BVSalud, Web of Science, and Periódicos CAPES. Studies investigating topical tranexamic acid in powder form for minor dental procedures were included. Reviews, in vitro or animal studies, and investigations focusing on systemic, injectable, or mouthwash formulations of tranexamic acid were excluded. Methodological quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute critical appraisal checklists.

Results: Ten studies met the inclusion criteria, including clinical trials, retrospective and prospective studies, case reports, and one letter to the editor. Tranexamic acid powder was applied directly to surgical sites or prepared as a paste or saline suspension, with doses ranging from 250 to 500mg. Most participants were receiving anticoagulant therapy or had underlying bleeding disorders, highlighting the need for effective local hemostatic approaches. All included studies reported successful bleeding control with topical tranexamic acid, frequently combined with additional local hemostatic measures such as sutures or gelatin sponges.

Conclusion: Topical tranexamic acid powder shows promise as an adjunctive measure for bleeding control in minor oral surgery, particularly in individuals at increased risk of hemorrhage. However, further studies are needed to clarify the isolated efficacy of tranexamic acid powder in dental bleeding management. Open Science Framework: https://osf.io/n5mbp

Keywords:
Tranexamic acid; Surgery, oral; Hemostasis

Author, year	Country	Study design	Sample size and study groups	Type of dental procedure	TXA administration methods	Outcomes*
Bernardoni-Socorro et al., 1998 ⁽¹⁴⁾	Venezuela	Clinical trial	Patients receiving anticoagulant therapy (n=15) treated with TXA (n=19 procedures) and a control group B without additional hemostatic measures (n=18 procedures)	Tartar removal, curettage, and dental extraction	A TXA tablet (250 mg) was crushed and diluted in 10 mL saline for postoperative bleeding control. TXA mouthwash was used for three minutes every six hours for seven days	TXA reduced bleeding in anticoagulated patients during dental procedures, including those with periodontal disease, without interruption of anticoagulant therapy
Blinder et al., 1999 ⁽¹⁸⁾	Israel	Clinical trial	Patients receiving anticoagulant therapy divided into three groups: RS and sutures (n=50); RS, sutures, and TXA mouthwash (n=50); and fibrin glue with RS and sutures (n=50)	Dental extraction	Local pressure was applied using gauze soaked in a TXA solution (500mg) diluted with saline. An RS was placed in the alveolar socket. For postoperative bleeding control, TXA mouthwash (500mg) was used for two minutes, four times daily for four days	Dental extractions were safely performed in anticoagulated patients using hemostatic measures such as RS, sutures, and TXA powder. However, severe periodontitis was associated with an increased risk of bleeding
Coetzee, 2007 ⁽¹⁹⁾	South Africa	Letter to the editor	Patients with hemophilia (n=30)	Dental extraction	TXA tablets (500mg) were crushed and placed on wet cotton wool positioned over the extraction site, and patient were instructed to apply pressure by biting for 30 minutes	Crushed TXA tablets could offer a cost-effective option for bleeding control in resource-limited settings, although further studies are required to confirm their effectiveness
Buhatem Medeiros et al., 2017 ⁽¹⁰⁾	Brazil	Case-control study	Patients receiving antiplatelet therapy (n=38) and a control group (n=35)	Dental extraction	A paste prepared from a crushed TXA tablet (250mg) mixed with saline was applied to the dental alveolus	Dual antiplatelet therapy was maintained during dental extraction. Although bleeding intensity was greater, bleeding was controllable using local measures, including crushed TXA tablets applied at the surgical site
Rocha et al., 2017 ⁽¹⁵⁾	Brazil	Retrospective study	Patients receiving anticoagulant therapy (n=126), antiplatelet therapy (n=53), or dual therapy (n=14)	Dental extraction	A TXA paste prepared from a crushed 250-mg tablet mixed with saline was used to soak the RS filling the alveolar socket. For postoperative bleeding control, TXA mouthwash (one tablet in 100 mL cold saline) was used four times daily for seven days	Postoperative bleeding was minimal in both groups. Local hemostatic measures, including TXA paste and RS, controlled bleeding without interruption of antithrombotic therapy
Lu et al., 2018 ⁽²¹⁾	Taiwan	Retrospective study	Patients receiving antiplatelet therapy (n=183) or VKA therapy (n=60)	Dental extraction	The extraction socket was repacked with Gelfoam impregnated with TXA powder. For postoperative bleeding control, TXA mouthwash used over several days was a convenient option	Interrupting warfarin therapy before dental extraction did not significantly reduce bleeding risk. Local hemostasis was achieved using crushed TXA tablets and other local measures
Rocha et al., 2019 ⁽⁴⁾	Brazil	Prospective cohort	Patients receiving VKA therapy (n=75) and non-anticoagulated controls (n=77)	Dental extraction	A TXA paste prepared from a crushed 250-mg tablet mixed with saline was used to soak the RS filling the alveolar socket. For postoperative bleeding control, TXA mouthwash (one tablet in 100mL cold saline) was used four times daily for seven days	Bleeding during dental extraction was similar between groups. TXA effectively controlled bleeding when used alongside additional local hemostatic measures
Rocha et al., 2020 ⁽¹⁶⁾	Brazil	Prospective cohort	Patients receiving DOACs (n=11) or VKA therapy (n=15) and non-anticoagulated controls (n=15)	Dental extraction	A TXA paste prepared from a crushed 250-mg tablet mixed with saline was used to soak the RS filling the alveolar socket. For postoperative bleeding control, TXA mouthwash (one tablet in 100mL cold saline) was used four times daily for seven days	Patients receiving DOACs exhibited a low risk of bleeding. TXA paste, used as part of a comprehensive local hemostatic approach, contributed effectively to bleeding control
Bhavyaa, 2021 ⁽²⁰⁾	India	Case report	A 7-year-old girl with GT	Dental extraction	A TXA tablet (500mg) was powdered, mixed with saline to form a paste, and placed into the socket. TXA mouthwash (500mg in 10mL water, 5%) was used six times daily for two days preoperatively	TXA paste applied to a soft plate effectively controlled bleeding in a patient with GT, highlighting its potential role in managing bleeding disorders
Souza et al., 2022 ⁽¹⁷⁾	Brazil	Retrospective study	Patients with liver disease (n=47)	Dental extraction and oral biopsy	TXA paste prepared from a crushed TXA tablet (250mg) mixed with saline was used to soak the RS filling the alveolar socket. For postoperative bleeding control, TXA mouthwash (one tablet in 100mL cold saline) was used four times daily for seven days	Patients with liver disease, thrombocytopenia, and a history of bleeding are at increased risk of hemorrhage. TXA, in combination with other local hemostatic measures, controlled bleeding and reduced the need for hospitalization

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[TFN1] ^*
Bleeding control was achieved using TXA in combination with additional local hemostatic measures.

[TFN2] DOAC: direct oral anticoagulant; GT: Glanzmann thrombasthenia; RS: resorbable sponge; TXA: tranexamic acid; VKA: vitamin K antagonist.