J Korean Assoc Oral Maxillofac Surg.  2019 Dec;45(6):343-350. 10.5125/jkaoms.2019.45.6.343.

When do we need more than local compression to control intraoral haemorrhage?

• Sohn JB
• Lee H
• Han YS
• Jung DU
• Sim HY
• Kim HS
• Oh S

• KMID: 2467186
• DOI: http://doi.org/10.5125/jkaoms.2019.45.6.343

Abstract

OBJECTIVES
The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required.
MATERIALS AND METHODS
Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage.
RESULTS
The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001).
CONCLUSION
A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

Keyword

Haemorrhage; Emergency treatment; Haemostasis; Anticoagulants; Oral surgery

MeSH Terms

Anticoagulants
Electrocoagulation
Emergency Service, Hospital
Emergency Treatment
Fibrinolytic Agents
Gingiva
Hemorrhage
Humans
Liver Cirrhosis
Male
Methods
Odds Ratio
Retrospective Studies
Risk Factors
Surgery, Oral
Sutures
Tooth Extraction
Tranexamic Acid
Anticoagulants
Fibrinolytic Agents
Tranexamic Acid

Figure

• 

  Fig. 1 Method of haemostasis used for intraoral haemorrhage. The values are presented as the number (%). (None: no treatment, Compression: simple direct local compression only with a small piece of sterile gauze applied to the site of haemorrhage, Local: local haemostatic agent, Electrocautery: bipolar or monopolar electrocautery, Extraction: extraction of causative tooth, Systemic: systemic administration of tranexamic acid or blood products)

• 

  Fig. 2 A. Number of patients. B. Percentile of patients. Comparison of cases stratified by whether or not a simple or complex method of haemostasis was performed according to the site of haemorrhage. P=0.169, univariable logistic regression test. The values are presented as the number or percentile. (Simple: simple method of haemostasis, Complex: complex method of haemostasis)

• 

  Fig. 3 A. Number of patients. B. Percentile of patients. Comparison of cases stratified by whether or not a simple or complex method of haemostasis was performed according to the cause of haemorrhage. P=0.019, univariable logistic regression test. Values are presented as the number or percentile. (Simple: simple method of haemostasis, Complex: complex method of haemostasis, Extraction: tooth extraction, Fixture: installation of a dental implant fixture, Trauma: physical trauma to tooth or gingiva, Periodontitis: local inflammation caused by periodontitis, Perio Tx: basic periodontal treatment including scaling or subgingival curettage, Surgery: minor oral surgery excluding tooth extraction and dental implant surgery, Drain: intraoral Penrose drain insertion, Cancer: oral cancer)

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