The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis

J Am Dent Assoc. 2023 Aug;154(8):742-752.e1. doi: 10.1016/j.adaj.2023.05.003. Epub 2023 Jun 27.


Background: Hemostatic agents are used to control bleeding after tooth extraction and have been compared with conventional measures (that is, sutures or gauze pressure) in several studies. The objective of this systematic review was to evaluate the benefits of topical hemostatic agents for controlling bleeding after tooth extractions, especially in patients receiving antithrombotic therapy.

Types of studies reviewed: The authors conducted a literature search in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials, including prospective human randomized clinical trials in which researchers compared hemostatic agents with conventional methods and reported the time to achieve hemostasis and postoperative bleeding events.

Results: Seventeen articles were eligible for inclusion. Hemostatic agents resulted in a significantly shorter time to achieve hemostasis in both healthy patients and patients taking antithrombotic drugs (standardized mean difference, -1.02; 95% CI, -1.70 to -0.35; P = .003 and standardized mean difference, -2.30; 95% CI, -3.20 to -1.39; P < .00001, respectively). Significantly fewer bleeding events were noted when hemostatic agents were used (risk ratio, 0.62; 95% CI, 0.44 to 0.88; P = .007). All forms of hemostatic agents (that is, mouthrinse, gel, hemostatic plug, and gauze soaked with the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, except for hemostatic sponges. However, this was based on a small number of studies in each subgroup.

Conclusions: The use of hemostatic agents seemed to offer better bleeding control after tooth extractions in patients on antithrombotic drugs than conventional measures.

Practical implications: Findings of this systematic review may help clinicians attain more efficient hemostasis in patients requiring tooth extraction. This systematic review is registered in the PROSPERO database. The registration number is CRD42021256145.

Keywords: Bleeding time; coagulants; fibrinolytic agents; hemorrhage; hemostasis; hemostatics; systematic review; tooth extraction.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Fibrinolytic Agents* / therapeutic use
  • Hemostatics* / therapeutic use
  • Humans
  • Postoperative Hemorrhage / drug therapy
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control
  • Prospective Studies
  • Tooth Extraction / adverse effects


  • Fibrinolytic Agents
  • Hemostatics