Surgical protocol
bleeding, Postextraction alveolar socket, tamponade, tooth, Bleeding, peripheral venous blood
CLOTS, BLEEDING, LOCAL INFILTRATION, STERILE, BLEEDING, EVENTS
Patients were instructed to take their medication, including FXa inhibitors, as usual. After local infiltration anesthesia with 4% articaine + epinephrine 1:200,000 (Ultracain D-S, Septodont GmbH, Niederkassel, Germany), tooth extraction on both sides of a jaw and curettage of the alveolar sockets was conducted by an experienced surgeon (investigator 1). The following steps were done by a different surgeon (investigator 2) who was not involved in the tooth extraction and did not conduct the postoperative control. Investigator 2 opened the closed envelopes with instructions for randomization and inserted a PRF plug in one socket (test group) and a solely hemostatic GS (Hygitec, Aegis Lifesciences) into the other one.For PRF, 10 ml peripheral venous blood per matrix was collected from the patient after a cephalic or median cubital vein puncture. The vacutainer system and specific sterile plain vacuum tubes (A-PRF, Mectron, Carasco, Italy) were used. For centrifugation, a fixed angle rotor with a radius of 110 mm with 1200 rpm and a relative centrifugal force of 177 g for 8 min was employed (Duo centrifuge, Mectron, Carasco, Italy), according to the manufacturer’s instructions. Ten minutes after the centrifugation, fibrin clots were prepared using the piston and cylinder assembly for 5 min (Xpression™ Box, IntraSpin, Intra-Lock, FL, USA) [Postextraction alveolar socket filled with a GS (Bleeding was assessed immediately after the surgery, after 30 min, 1 h, 1.5 h, and on follow-up appointments at 24 h, and on the 7th day after the tooth extraction by investigator 1, who was blinded to the hemostatic material. The results on the day of extraction were interpreted as follows: no bleeding, bleeding which stopped after 30 min of gauze tamponade, bleeding which stopped after 1-h gauze tamponade, and bleeding which stopped after 1.5 h of gauze tamponade. Patients were instructed to use pressure with gauze tamponades in domestic bleeding events. In cases of unstoppable bleeding, patients were asked to return to the department. Bleeding events were classified into mild bleeding/oozing stopped via local pressure, moderate bleeding needing interventions than local pressure, and severe bleeding urgently needing interventions.