ABSTRACT Effective bleeding control during dental extractions is an increasing clinical challenge in patients receiving oral antithrombotic therapy (OAT). Previous systematic reviews have grouped various local hemostatic interventions together, potentially obscuring subtle differences in their true efficacy. To clarify the comparative effectiveness of individual interventions, we conducted a network meta‐analysis (NMA) evaluating local hemostatic methods in patients undergoing dental extractions while on OAT. A comprehensive literature search was performed in PubMed, the Cochrane Central Register of Controlled Trials, and Ichu‐shi from January 1 to July 30, 2024, without language restrictions. Two independent reviewers screened studies, assessed the risk of bias using a standardized tool, and extracted data on bleeding events, which were synthesized using a frequentist NMA model. Four randomized controlled trials (RCTs) were ultimately included. Although interventions incorporating tranexamic acid achieved relatively high statistical ranking scores, none of the individual interventions provided a statistically significant improvement in bleeding control compared with simple gauze compression. The overall certainty of evidence was very low due to small sample sizes and methodological limitations. Although these findings suggest that simple gauze compression may provide adequate bleeding control as an initial treatment, the very low certainty of evidence precludes definitive clinical recommendations. Further high‐quality RCTs are urgently needed to optimize bleeding management protocols in this patient population.
Isaka et al. (Mon,) studied this question.