Comparison of post-extraction bleeding control in patients on dual antiplatelet therapy: A randomized controlled trial evaluating the efficacy of 470nm Blue laser, Tranexamic Acid and Chitosan.

This study is a randomized, double blind, parallel group trial comparing the efficacy of 470nm blue laser, Tranexamic acid and Chitosan dressing controlling post - extraction bleeding in patients on DAPT (Dual antiplatelet drug therapy). Patients on DAPT requiring any tooth removal in the upper& lower molars are included in the study.  Haemostasis following a tooth extraction is essential to prevent excessive blood loss prevent further sequelae of complications. Tooth extraction in patients on antiplatelet drugs cause prolonged post-extraction bleeding.  Antiplatelet drugs are prescribed for heart disease/ stroke patients. Dual antiplatelet drug therapy (DAPT) refers to any combination of 2 different antiplatelet drugs. In literature, it is proved that simple extraction is considered as low bleeding risk procedure, which can be operated without interruption of DAPT in patients. Although there are established AHA/SCOTTISH/NICE guidelines provided- not to interrupt DAPT for simple extraction, still general physicians/cardiologists recommend to discontinue DAPT for simple extraction would lead to further increased risk of venous thromboembolic events in the patients. In this study there is no needfor interruption of DAPT for simple extraction of any molars in the upper & lower jaws, with concurrent bleeding risk, henceforth we intervene with various bleeding control agents- chitosan, tranexamic acid&470nm blue light laser   for control of post operative bleeding & evaluating the efficacy of using above 3 mentioned interventions to control post operative bleeding is studied. Primary Outcome: To evaluate the control of post extraction bleeding in patients using DAPT following various haemostatic measures. Secondary: To compare the control of post-extraction bleeding using interventions with the patients discontinuing DAPT for 3-5 days as control. To compare the time to achieve haemostasis. To assess the total amount of blood loss after the extraction using the Gravimetric method.  To evaluate the incidence of any post-operative complications (such as haematoma, or wound infection, reactionary haemorrhage. Patient satisfaction using a 5-point Likert scale. Pain levels using Visual analogue scale. To compare the need for any additional haemostatic interventions. Patient will be subjected for extraction of single molar, As per the included group, specific interventions will be performed. Visual examination bleeding and will be confirmed using Filter paper method. In all the group’s Figure of 8 suturing will be done using 3-0 black silk sutures & evaluated for Hemostatis confirmed using Filter paper method &Time for Hemostasis. Total amount of blood loss using Gravimetric method, Wound healing scale using Landrys healing index, Post- operative complications, Satisfaction – 5 point Likert scale, Post-operative Pain using VAS & Need for any other hemostatic  interventional methods like bonewax, cautery etc..