In clinical dentistry, it is not uncommon to encounter situations involving bleeding, such as traumatic injuries and intraoperative procedures, where hemostasis is difficult to achieve. In addition, patients with various hematologic diseases and those undergoing antithrombotic therapy must be well understood and prepared for replacement therapy and local hemostasis before surgery.
The body's hemostatic mechanism functions to maintain a balance between thrombogenic action, which seals the injured area with a hemostatic thrombus, and antithrombotic action, which prevents unnecessary thrombus formation. Bleeding tendency is also observed in the presence of local inflammation in addition to various hematologic and systemic diseases. On the other hand, if antithrombotic drugs are administered for thrombophilia, hemostasis may be difficult to achieve during tooth extraction or surgery.
If thrombocytopenia or coagulation factor deficiency is present, systemic replacement therapy is performed, but the basic principle of hemostasis is localized hemostasis. In dentistry, the basic approach is compression hemostasis, and if hemostasis is difficult, local hemostatic agents or a hemostatic splint may be used. Guidelines for tooth extractions in antithrombotic therapy patients recommend that, in principle, teeth should be extracted without drug withdrawal, increasing the importance of local hemostasis.
In this context, future development of simple screening tests that reflect each stage of the hemostatic mechanism and local hemostatic agents suited to the situation is expected.
