Blue-violet light-emitting diode irradiation in combination with hemostatic gelatin sponge (Spongel) application ameliorates immediate socket bleeding in patients taking warfarin Toshihiro Okamoto, DDS, PhD, a Isao Ishikawa, DDS, PhD, b Akira Kumasaka, DDS, c Seigo Morita, DDS, d Sayaka Katagiri, DDS, PhD, e Teruo Okano, DEng, PhD, f and Tomohiro Ando, DDS, PhD g Tokyo Women’s Medical University and Tokyo Medical and Dental University, Tokyo, Japan Objective. The control of bleeding after tooth extraction is a major concern in patients taking warfarin. Light-emitting diode (LED) irradiation with hemostatic gelatin sponge application was investigated. Study Design. Patients who took warfarin and required tooth extraction were divided randomly into 3 groups. The first group was irradiated with blue-violet LED after tooth extraction. The second group was treated with a hemostatic gelatin sponge and LED irradiation. The third group was treated with only hemostatic gelatin sponges. Hemostasis was evaluated at 30 seconds after treatment. Results. Less than 30% of the patients achieved hemostasis within 30 seconds in the hemostatic sponge group; approximately 50% of the patients in the simple LED irradiation group achieved hemostasis within 30 seconds; and 86.7% of the patients in the LED and hemostatic sponge combined group achieved hemostasis within 30 seconds, indicating that combined treatment with LED and hemostatic sponges provided a significantly higher hemostasis than in the hemostatic sponge group (P < .01). Conclusions. Blue-violet LED irradiation combined with hemostatic gelatin sponge treatment yielded hemostasis of the extraction socket within 30 seconds without suture in most cases. (Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:170-177) Warfarin is commonly prescribed as an anticoagulant to prevent thromboembolism. More than 4 million patients in North America and 1 million patients in Japan take oral anticoagulants every day due to the presence of mechanical heart valves, atrial fibrillation, brain infarction, and deep vein thrombosis. 1,2 Patients who require tooth extraction and whose prothrombin timeeinternational normalized ratio (PT-INR) values are below 4.0 are encouraged to continue warfarin therapy without dose adjustments, because the risk of thromboembolism after stopping warfarin therapy outweighs the risk of oral bleeding. 3,4 However, warfarin treatment impairs clotting, and patients consequently have an increased risk of bleeding during and after tooth extraction. 5 The British Committee for Standards in Haematology published guidelines for the management of patients on oral anti- coagulants who required dental surgery. They recom- mend the use of oxidized cellulose or collagen sponges and suture to minimize the risk of bleeding. 6 However, extraction sockets are generally open wounds, and tight closure is sometimes difficult. In fact, Morimoto et al. recently reported that surgical tooth extraction and acute inflammatory findings are associated with a significantly increased incidence of postoperative hemorrhage in patients receiving antithrombotic therapy. 7 Our laboratory previously reported that irradiation with blue-violet light-emitting diodes (LEDs) imme- diately stops socket bleeding after tooth extraction. 8 A blue-violet LED that emits a specific range of wavelengths (380-515 nm) with 2 dominant peaks at approximately 410 and 470 nm is commercially available for the polymerization of composite resin for filling dental cavities. 8 Visible blue-violet light from this LED is also selectively absorbed by red The authors thank Ivoclar Vivadent AG for providing the bluephase G2 device under investigation by our request. a Associate Professor, Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University. b Consultant, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University. c Assistant Professor, Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University. d Research Fellow, Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University. e Assistant Professor, Department of Periodontology, Tokyo Medical and Dental University. f Director, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University. g Professor and Chairman, Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University. Received for publication May 22, 2013; returned for revision Sep 5, 2013; accepted for publication Sep 9, 2013. Ó 2014 Elsevier Inc. All rights reserved. 2212-4403/$ - see front matter http://dx.doi.org/10.1016/j.oooo.2013.09.009 Statement of Clinical Relevance Bleeding control after tooth extraction is inevitable in patients taking warfarin. A novel photocoagula- tion method using blue-violet light-emitting diode in combination with hemostatic gelatin sponge appli- cation ameliorated the hemostasis of the extraction socket. Most of the bleeding was stopped within 30 seconds. 170 Vol. 117 No. 2 February 2014