{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:07:48Z","timestamp":1778598468633,"version":"3.51.4"},"reference-count":10,"publisher":"California Digital Library (CDL)","issue":"2","license":[{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent currently approved and utilized in the treatment of dysfunctional uterine bleeding, traumatic extracranial hemorrhage, anterior epistaxis, and dental procedures on patients with hemophilia. There is a paucity of literature evaluating the use of TXA for hemostasis in patients on direct oral anticoagulants (DOACs).\n\nCase Report: Our patient, a 72 year-old male on rivaroxaban, presented with persistent bleeding following a punch biopsy of the buccal mucosa. Given the site of bleeding, inability to effectively tamponade, patient\u2019s anticoagulated state, and risk of impending airway compromise, a dressing was soaked with 500 milligram (mg) of TXA and was held in place with pressure using a makeshift clamp until a thrombus formed. Hemostasis was achieved preventing the need for acute ENTotolaryngologic intervention and\/or intubation. The patient was observed in the medical setting overnight and discharged home without any recurrence of bleeding or adverse events.\n\nDiscussion: This case report describes our experience achieving hemostasis for an otherwise uncontrollable oral bleed in an anticoagulated patient on a DOAC who could not be reversed. Intervention is simple to perform, cost-effective, and requires few resources which are readily available in most emergency departments.\n\nConclusion: We report a novel application of TXA to control an oral mucosal bleed in an anticoagulated patient which was on a DOAC refractory to traditional measures.<\/jats:p>","DOI":"10.5811\/cpcem.2020.1.45326","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T22:20:40Z","timestamp":1588717240000},"page":"146-149","source":"Crossref","is-referenced-by-count":6,"title":["Topical Tranexamic Acid for Hemostasis of an Oral Bleed in a Patient on a Direct Oral Anticoagulant"],"prefix":"10.5811","volume":"4","author":[{"given":"Eric","family":"Boccio","sequence":"first","affiliation":[{"name":"Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut; Yale-New Haven Hospital, Department of Emergency Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"Hultz","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambrose","family":"Wong","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut; Yale-New Haven Hospital, Department of Emergency Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2020,3,27]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systemic review and cumulative meta-analysis. BMJ. 2012;344:e3054.","DOI":"10.1136\/bmj.e3054"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Roberts I, Perel P, Prieto-Merino D, et al. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ. 2012;345:e5839.","DOI":"10.1136\/bmj.e5839"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Nishijima DK, Kuppermann N, Roberts I, et al. The effect of tranexamic acid on functional outcomes: an exploratory analysis of the CRASH-2 randomized controlled trial. Ann Emerg Med. 2019;74(1):79-87.","DOI":"10.1016\/j.annemergmed.2018.11.018"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Akkan S, Corbacioglu SK, Aytar H, et al. Evaluating effectiveness of nasal compression with tranexamic acid compared with simple nasal compression and merocel packing: a randomized controlled trial. Ann Emerg Med. 2019;7(1):72-8.","DOI":"10.1016\/j.annemergmed.2019.03.030"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998;158(15):1610-6.","DOI":"10.1001\/archinte.158.15.1610"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Coetzee MJ. The use of topical crushed tranexamic acid tablets to control bleeding after dental surgery and from skin ulcers in haemophilia. Haemophilia. 2007;13(4):443-4.","DOI":"10.1111\/j.1365-2516.2007.01479.x"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Borea G, Montebugnoli L, Capuzzi P, et al. Oral Surg Oral Med Oral Pathol. 1993;75(1):29-31.","DOI":"10.1016\/0030-4220(93)90401-O"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Nuvvula S, Gaddam KR, Kamatham R. Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling in cases of hemophilia: a randomized clinical trial. Contemp Clin Dent. 2014;5(1):49-53.","DOI":"10.4103\/0976-237x.128663"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Engelen ET, Schutgens RE, Mauser-Bunschoten EP, et al. Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions. Cochrane Database Syst Rev. 2018;7:CD012293.","DOI":"10.1002\/14651858.cd012293.pub2"},{"key":"ref9","unstructured":"(2017). Cyklokapron\u00ae (tranexamic acid injection) [package insert]. New York, NY: Pharmacia & Upjohn Co, Division of Pfizer Inc."}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T20:37:30Z","timestamp":1595277450000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/5rh1q5t3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,27]]},"references-count":10,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2020.1.45326","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"value":"2474-252X","type":"electronic"},{"value":"2474-252X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,3,27]]}}}