Usefulness of platelet-rich fibrin as a hemostatic agent after dental extractions in patients receiving anticoagulant therapy with factor Xa inhibitors: a case series

  • Carlos Fernando de Almeida Barros Mourão
  • Richard J Miron
  • Rafael Coutinho de Mello Machado
  • Shahram Ghanaati
  • Gutemberg Gomes Alves
  • Mônica Diuana Calasans-Maia
Case Report



To evaluate the clinical outcomes of platelet-rich fibrin (PRF) application for hemostasis after dental extraction in patients receiving anticoagulant therapy with factor Xa inhibitors.


In total, 25 patients receiving anticoagulant therapy with rivaroxaban or apixaban who required routine dental extraction were evaluated. In all patients, PRF was used for hemostasis in addition to adapting sutures. Bleeding was subjectively assessed using a sterilize gauze pad at 24, 48, and 72 h after the procedure.


All invited participants (n = 25) consented to participate. The PRF clots successfully arrested bleeding after extraction in all patients, with no complications at any time point after the procedure. Favorable soft tissue healing was observed during suture removal at 10 days after the procedure in all patients, with no signs of infection or late healing.


The results of this case series indicate that PRF is a promising natural hemostatic agent for the management of bleeding after dental extraction in patients receiving factor Xa inhibitor therapy. Further controlled clinical studies with larger patient samples are necessary to clarify the findings of this case series.


Platelet-rich fibrin Anticoagulant therapy Clot stability Hemostasis Dental extraction 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Carlos Fernando de Almeida Barros Mourão
    • 1
    • 2
  • Richard J Miron
    • 3
  • Rafael Coutinho de Mello Machado
    • 2
  • Shahram Ghanaati
    • 4
  • Gutemberg Gomes Alves
    • 1
  • Mônica Diuana Calasans-Maia
    • 2
  1. 1.Department of Molecular and Cell Biology, Institute of BiologyFluminense Federal UniversityNiteróiBrazil
  2. 2.Department of Oral Surgery, Dentistry SchoolFluminense Federal UniversityNiteróiBrazil
  3. 3.Department of PeriodontologyUniversity of BernBernSwitzerland
  4. 4.Department of Maxillofacial, Clinic for Maxillofacial and Plastic SurgeryJohann Wolfgang Goethe UniversityFrankfurt Am MainGermany

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