II. Indications
- 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)
- See Control of Hemorrhage after Tonsillectomy
- Consult Orofacial Surgery, Otolaryngology or Dentist
- Gargled Tranexamic Acid (TXA) 5% Mouthwash
- Prepare Tranexamic Acid (TXA) 5% Mouthwash
- Tranexamic Acid (TXA) is available in 1000 mg/10 ml vials that contain 10 ml
- Prepare 2 small cups each of 5 ml TXA (500 mg) and 5 ml cold water (10 ml of diluted TXA per cup)
- Alternatively a 500 to 650 mg TXA tablet may be dissolved in 10-15 ml water
- Have patient gargle 10 ml for 1-2 minutes and then gently spit out solution
- May repeat again in 10-15 minutes
- Prepare Tranexamic Acid (TXA) 5% Mouthwash
- Local Bleeding Control
- Insert bite block
- Anesthetize area (cetacaine or atomized Lidocaine via MADD)
- Apply pressure with finger to bleeding site
- Apply Tranexamic Acid (TXA) or Epinephrine soaked gauze directly against bleeding site with McGill forceps
- For patients on Warfarin, apply Topical Thrombin solution soaked cotton pledget (from dental box) to bleeding area
- Topical Thrombin is typically supplied as 5000 IU bottle with 5 ml bottle saline diluent (1000 IU/ml)
- Inject Epinephrine into bleeding site
V. Management: Home
- Home use of TXA for mild residual bleeding (expert opinion based on limited evidence)
- Dissolve one 650 mg Tranexamic Acid Tablet (Lysteda) in 4 oz water
- Take one ounce of solution, swish, gargle for 2 minutes, and spit
- May be repeated several times at home as needed for mild residual bleeding
- Postoperative Bicarbonate Solution for Prevention of Recurrent Bleeding (expert opinion, per otolaryngology protocols)
- Rinse mouth with warm Sodium Bicarbonate oral solution four times daily and after eating
- Warm solution increases coagulation
- Preparation of bicarbonate solution
- Mix one tablespoon of Baking Soda in one liter of water
- Dispose of any solution remaining after one week
- Rinse mouth with warm Sodium Bicarbonate oral solution four times daily and after eating
VI. Resources
- TXA for Epistaxis and Oral Bleeding (RebelEM)