***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: This prospect i ve r and omized study analyses the use of a prescribed 4.8 % tranexamic acid post-operative mouthwash over 2 days vs 5 days to prevent bleeding in patients taking warfarin who require dental extraction s. Eighty-five patients therapeutically anticoagulated with warfarin for various conditions , ranging in age from 21 to 86 years and requiring dental extraction s , were r and omly divided into two groups . Group A postoperatively received a 4.8 % tranexamic acid mouthwash to be used over a 2-day period . Group B received the same mouthwash and instructions postoperatively , to be taken over 5 days . All procedures were performed on an ambulatory basis under local anaesthetic by the same surgeon . Patients were review ed 1 , 3 , and 7 days postoperatively to assess bleeding . Eighty-two of the 85 patients encountered no postoperative problems . Two patients in group A and one in group B had minor postoperative bleeds that required minor ambulatory intervention to control . This study shows that a 2-day postoperative course of a 4.8 % tranexamic acid mouthwash is as equally effective as a 5-day course in controlling haemostasis post-dental extraction s in patient 's anticoagulated with warfarin Introduction Oral anticoagulants are widely prescribed drugs . Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy . The purpose of this study was to evaluate the incidence of bleeding complications after dental extraction s in patients on anticoagulant therapy ( warfarin ) in whom different local hemostatic methods were used . Material and methods Patients using warfarin and requiring extraction s of at least two teeth were screened to participate in this prospect i ve , r and omized study . Extraction sites were considered as sampling units ( statistically representative sample size ) and were allocated to one of the three study groups ( G1—4.8 % tranexamic acid ; G2—fibrin sponge ; and G3—no local hemostatic agents ) . Results Eighty-four extraction sites were obtained from patients with mitral valve prolapse ( 47.4 % ) , prosthetic cardiac valve ( 23.7 % ) , venous thromboembolism ( 21.1 % ) , and pulmonary embolism ( 5.2 % ) .  International normalized ratio ( INR ) values ranged between 2.1 and 3.1 ( mean 2.51 ± 0.1 ) . Postoperative bleeding was observed in four surgical sites ( p < 0.001 ) and was mainly in older patients ( p = 0.005 ) . Discussion The three local hemostatic protocol s were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin .  The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This study evaluated the early hemostatic effects of a novel hemostatic agent ( Ankaferd blood stopper [ ABS ] ) during dental extraction s in patients on antithrombotic therapy  , without interruption or diminution of the medication . In total , 25 patients , who are on antithrombotic therapy and in need of simple dental extraction s , were r and omized into 2 groups . In group I ( control group ) , which consisted of 10 patients , local hemostasis was achieved with direct packing with gauze . In group II , which consisted of 15 patients , local hemostasis was achieved by the local application of ABS on the extraction sockets . The bleeding time was compared between 2 groups following the tooth extraction . The bleeding time in the dental sockets treated with ABS was statistically lower compared to the sockets of the control group ( p = 0.0001 ) . It is concluded that the dental extraction s could be performed without interruption of the medication in patients on antithrombotic therapy . The ABS appears to be sufficient as an alternative hemostatic agent PURPOSE To evaluate postoperative bleeding and thromboembolic complications during dental extraction s in anticoagulated patients , using 2 different protocol s. PATIENTS AND METHODS In total , 214 anticoagulated patients in need of simple dental extraction s were r and omized into 2 groups . Group A consisted of 109 patients on continuous oral anticoagulation therapy ( OAT ) , with a mean international normalized ratio ( INR ) of 2.45 + /- 0.54 . Local hemostasis in these patients was achieved with resorbable collagen sponges , without wound suturing . Group B consisted of 105 patients on bridging therapy with low-molecular-weight heparin ( nadroparin-calcium ) , with a mean INR of 1.26 + /- 0.11 on the day of the procedure . Neither local hemostatic agents nor suturing of the wound was used in these patients . RESULTS Eight ( 7.34 % ) patients in group A and 5 ( 4.76 % ) patients in group B manifested post extraction al bleeding , without statistical significance ( chi(2 ) , Yates ' = 0.253 , P > .05 ) . All cases of hemorrhage were mild and easily controlled using local hemostatic measures . None of the participants in either group experienced thromboembolic complications . CONCLUSIONS In patients receiving OAT with an INR < or=4.0 , simple dental extraction s can be performed safely without interruption or modification of OAT , using local hemostatic measures . Suturing of the wound should be reserved for cases with a greater extent of surgical trauma , and when primary hemostasis is insufficient . There is no need for bridging therapy with low-molecular-weight heparin in patients undergoing minor dentoalveolar procedures , although this approach can be used in patients with major oral surgical interventions OBJECTIVE The objective of this study was to compare the use of a resorbable oxycellulose dressing with a fibrin adhesive for the prevention of post extraction hemorrhage in patients taking anticoagulants . STUDY DESIGN A control group of 26 patients with a preoperative international normalized ratio ( INR ) in the range of 2.0 to 4.2 had extraction s performed with the use of local anesthesia  and the socket(s ) dressed with a resorbable oxycellulose dressing and sutured with a resorbable suture . The study group with a comparable INR range of 2.1 to 4.1 was treated in a similar manner , except the sockets were dressed with a fibrin adhesive . RESULTS No discernible difference in the postoperative outcome with regard to hemorrhage was noted . Postoperative pain was reported more frequently in the group that used a resorbable oxycellulose dressing . Only 1 patient had significant postoperative bleeding . CONCLUSIONS This study shows that in patients receiving warfarin whose INR is within the therapeutic range , the fibrin adhesive is as effective as the resorbable oxycellulose dressing in preventing post extraction hemorrhage Objectives To examine the consequences of temporary withdrawal of warfarin and /or suturing on bleeding and healing pattern following dental extraction s. Methods Two hundred and fourteen patients on long-term oral anticoagulation ( warfarin ) therapy scheduled for dental extraction were r and omly divided into four groups : no suturing and discontinued ( group 1 ) or continued warfarin ( group 2 ) , and suturing and discontinued ( group 3 ) or continued warfarin ( group 4 ) . International normalised ratio ( INR ) was determined at different time points ( baseline , days 1 , 3 and 7 ) . Results Discontinuing warfarin reduced INR level significantly at day 1 , which subsequently reached < 1.5 in 96 out of 104 patients ( group 1 and 3 ) . Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern . Interestingly , patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls . Conclusion Dental extraction s may be safely performed for patients on anticoagulation therapy provided the INR level is kept < 3.0 and effective measures of local haemostasis are administered . The decision to suture should be made on case-by-case basis , as the trauma associated with soft tissue h and ling might outweigh its advantages in certain situations like simple extraction Objectives The aim of this study was to vali date a st and ardized pragmatic approach to manage new oral anticoagulants ( NOACs ) in patients who undergo dental extraction s. Material s and methods This prospect i ve case-control study in patients undergoing dental extraction included 26 patients ( mean age 76 years , 57 % male ) treated with dabigatran , rivaroxaban , or apixaban and 26 matched controls .  Regardless of timing of extraction , drug regimen , or renal function , patients were instructed to skip only the dose on the morning of the procedure . A procedural bleeding score was recorded and early and delayed bleeding was assessed at day 1 and day 7 . Bleeding events were compared with a prospect ively matched control group not taking any antithrombotic drug . Results There was no difference in the procedural bleeding score or in early bleeding events ( 5 in both groups ) . However , delayed bleeding occurred more frequently in anticoagulated compared to non-anticoagulated patients ( 7 versus none , p = 0.01 ) . Conclusions Skipping the morning dose of NOACs avoids excess bleeding during and early after the procedure . However , anticoagulated patients had an increased risk of delayed bleedings . Further study is needed to determine the optimal post-procedural management . Clinical relevance This is the first prospect i ve study for the management of patients on NOACs undergoing dental extraction . Our pragmatic approach , omitting only a single morning dose , can guide clinical practice . Both patients and physicians should be aware of the increased delayed bleeding risk BACKGROUND / AIM Patients receiving long-term oral anticoagulant therapy  pose a clinical challenge during invasive dental procedures . The goal of this study was to compare different local hemostatic modalities after tooth extraction in patients receiving chronic Vitamin-K antagonist therapy .  METHODS Totally 90 patients with International Normalized Ratio ( INR ) ≤ 3.0 requiring simple extraction of one or two teeth were r and omized into three groups , 30 patients in each group . The patients with the mean INR value of 2.35 ± 0.37 , in whom extraction wound was sutured comprised the group A. In the group B with the mean INR of 2.43 ± 0.4 , local hemostasis was achieved by placing absorbable gelatin sponges into the wound without suturing . The group C consisted of the patients with the mean INR of 2.36 ± 0.34 in whom neither gelatin sponge nor suturing were used for providing local hemostasis . Bleeding was registered as an event if other than initial hemostatic measure was needed or additional oral surgeon intervention required . RESULTS The obtainded results show that 1 ( 3.3 % ) patient in the group A , 2 ( 6.7 % ) patients in the groups B and C manifested post- extraction bleeding . All cases of hemorrhage were easily solved with local hemostatic measures and all , except one case , were registered in the first two hours after the procedure until the dismissal . A difference between the groups was not statistically significant ( χ2 = .42 , p > 0.05 ) . CONCLUSION In therapeutically anticoagulated patients tooth extraction s can be safely performed without altering the dose of anticoagulant medication if efficient local hemostasis is provided . In most cases ; in patients with INR ≤ 3.0 after extraction of one or two teeth postoperative bleeding can be controlled with local pressure , without any additional local hemostatic measures PURPOSE This study assessed the risk associated with several schedules of perioperative treatment with coumadin in anticoagulated patients who underwent oral surgery . PATIENTS AND METHODS A prospect i ve , r and omized study compared bleeding complications with six perioperative schedules in 92 patients chronically treated with acenocoumarol .  In three of the perioperative schedules , the dose was reduced before surgery and calcium heparin was added . In the other three , oral anticoagulation was not modified and heparin was not used . The groups also differed regarding the antifibrinolytic agents used and the postoperative measures applied . RESULTS Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was applied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those in whom oral anticoagulation was reduced and calcium heparin was added preoperatively . CONCLUSIONS In orally anticoagulated patients who undergo oral surgery , schedules that maintain the oral anticoagulant regimen and use local tranexamic acid as an antifibrinolytic agent postoperatively for 2 days are safe , simple , and less troublesome PURPOSE Our goal was to evaluate the local hemostatic effect of n-butyl-2-cyanoacrylate ( Histoacryl ; B. Braun , Melsungen , Germany ) glue in warfarin-treated patients who undergo outpatient oral surgery without a change in their level of anticoagulation . MATERIAL S AND METHODS Thirty consecutive warfarin-treated patients r and omly assigned to study and control groups and 10 patients who had never been on anticoagulant therapy serving as the negative control group were included in this trial . Before multiple teeth extraction s , 
    Output:
    
In patients treated with vitamin K antagonists , tranexamic acid mouthwash significantly reduced bleeding compared to placebo .
Further , histoacryl glue was proven better than gelatin sponges .
Other studies failed to show significant differences between haemostatics , but bleeding events were low .
Conclusions Tranexamic acid seems to effectively reduce bleeding , although its superiority to other haemostatics was not proven .