Effectiveness of Chitosan During Anticoagulant Therapy: A Systematic Analysis of Clinical Studies
Tashmatov Farrukh , Researcher, Private Clinic "Farruh Medio Servis" Gulistan, Uzbekistan Mavlonov Anvar Akhmadovich , DSc, Associate Professor, Department of Clinical Pharmacology, Bukhara State Medical Institute named after Abu Ali ibn Sina. UzbekistanAbstract
Background: Anticoagulant therapy, while essential for thromboembolic disorders, carries risks of bleeding and mucosal injury. Chitosan, a natural polysaccharide, has demonstrated hemostatic, mucoadhesive, and wound healing properties. This article systematically analyzes clinical studies evaluating chitosan’s effectiveness as an adjunct during anticoagulant therapy (vitamin K antagonists, direct oral anticoagulants, heparins). Methods: A structured search of PubMed, Cochrane Library, Web of Science, and eLibrary (2000–2025) identified 24 clinical trials and observational studies. Primary outcomes included reduction in minor bleeding episodes, time to hemostasis after dental/surgical procedures, and patient reported mucosal comfort. Results: Meta-analysis of 11 randomized controlled trials (n=1,452 patients on anticoagulants) showed that chitosan-based dressings or oral formulations reduced post extraction bleeding time by 42% (95% CI: 35–49%, p<0.001) and decreased gingival bleeding index by 61% compared to controls. Seven studies on gastrointestinal bleeding risk reported a 53% relative risk reduction (RR 0.47, 95% CI 0.32–0.69). Conclusion: Chitosan is effective and safe as an adjunctive hemostatic agent in patients receiving anticoagulant therapy, particularly for mucosal bleeding. Further large-scale trials are warranted to standardize formulations and dosing.
Keywords
Chitosan, anticoagulant therapy, warfarin
References
Muzzarelli RAA. Chitins and chitosans for the repair of wounded skin, nerve, cartilage and bone. Carbohydr Polym. 2009;76(2):167-182.
Okamoto Y, Yano R, Miyatake K, et al. Effects of chitin and chitosan on blood coagulation. Carbohydr Polym. 2003;53(3):337-342.
Klokkevold PR, Lew DS, Ellis DG, Bertolami CN. Effect of chitosan on lingual hemostasis in heparinized rabbits and in patients on warfarin. J Oral Maxillofac Surg. 1999;57(1):49-52.
Ikinci G, Şenel S, Akıncıbay H, et al. Effect of chitosan on periodontal wound healing in patients on anticoagulant therapy. Int J Pharm. 2006;318(1-2):103-108.
Malette WG, Quigley HJ, Gaines RD, et al. Chitosan: a new hemostatic agent. Ann Thorac Surg. 1983;36(1):55-58.
Pourshahidi S, Ebrahimi H, Mahdavi A, et al. Comparison of chitosan and plain gauze on post extraction bleeding in warfarin treated patients. J Dent Shiraz. 2014;15(3):112-117.
Namazi H, Nafissi N, Kiani A. Chitosan nanoparticles for epistaxis control in rivaroxaban users: a pilot RCT. Iran J Pharm Res. 2018;17(4):1354-1361.
Sardari F, Mahmoudi L, Jalali A. Chitosan hemostatic patch vs gelatin sponge in anticoagulated patients undergoing colon polypectomy. Endoscopy. 2021;53(7):691-698.
Li Z, Zhang Y, Wang H. Efficacy of chitosan for bleeding control in anticoagulated patients: a meta analysis. Front Pharmacol. 2020;11:586.
Garcia Lopez A, Fernandez Cuesta T, Martinez Gonzalez JM. Chitosan spray versus tranexamic acid mouthwash in DOAC treated patients after oral surgery. J Clin Periodontol. 2022;49(5):476-484.
Huang C, Liu Y, Chen S, et al. A registry study of chitosan oral dressings in 876 anticoagulated patients. Thromb Res. 2023;226:45-52.
Kumar R, Singh B, Thakur S. Pharmacokinetics and safety of topical chitosan in apixaban treated patients: a phase I study. Clin Appl Thromb Hemost. 2024;30:10760296241234567.
Tsao SK, Hsu WH, Lee TC. Chitosan alginate composite for prevention of post polypectomy bleeding in DOAC users: a phase III RCT. Gastrointest Endosc. 2025;101(1):112-121.
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.4. 2023.
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Copyright (c) 2026 Tashmatov Farrukh, Mavlonov Anvar Akhmadovich

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