II. Indications

  1. Bleeding after dental (Tooth Extraction) or other oral procedures

III. Risk Factors

IV. Management: Excessive Bleeding following Oropharyngeal Procedure (Expert Opinion based on limited evidence)

  1. See Control of Hemorrhage after Tonsillectomy
  2. Consult Orofacial Surgery, Otolaryngology or Dentist
  3. Gargled Tranexamic Acid (TXA) 5% Mouthwash
    1. Prepare Tranexamic Acid (TXA) 5% Mouthwash
      1. Tranexamic Acid (TXA) is available in 1000 mg/10 ml vials that contain 10 ml
      2. Prepare 2 small cups each of 5 ml TXA (500 mg) and 5 ml cold water (10 ml of diluted TXA per cup)
      3. Alternatively a 500 to 650 mg TXA tablet may be dissolved in 10-15 ml water
    2. Have patient gargle 10 ml for 1-2 minutes and then gently spit out solution
    3. May repeat again in 10-15 minutes
  4. Local Bleeding Control
    1. Insert bite block
    2. Anesthetize area (cetacaine or atomized Lidocaine via MADD)
    3. Apply pressure with finger to bleeding site
    4. Apply Tranexamic Acid (TXA) or Epinephrine soaked gauze directly against bleeding site with McGill forceps
    5. For patients on Warfarin, apply Topical Thrombin solution soaked cotton pledget (from dental box) to bleeding area
      1. Topical Thrombin is typically supplied as 5000 IU bottle with 5 ml bottle saline diluent (1000 IU/ml)
    6. Inject Epinephrine into bleeding site

V. Management: Home

  1. Home use of TXA for mild residual bleeding (expert opinion based on limited evidence)
    1. Dissolve one 650 mg Tranexamic Acid Tablet (Lysteda) in 4 oz water
    2. Take one ounce of solution, swish, gargle for 2 minutes, and spit
    3. May be repeated several times at home as needed for mild residual bleeding
  2. Postoperative Bicarbonate Solution for Prevention of Recurrent Bleeding (expert opinion, per otolaryngology protocols)
    1. Rinse mouth with warm Sodium Bicarbonate oral solution four times daily and after eating
      1. Warm solution increases coagulation
    2. Preparation of bicarbonate solution
      1. Mix one tablespoon of Baking Soda in one liter of water
      2. Dispose of any solution remaining after one week

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