• Santhosh Kumar saveetha dental college, saveetha university, chennai, india


Bleeding intraoperatively and postoperatively in oral surgery poses a great threat to the patient and can lead to serious untoward consequences if
uncontrolled. The dentist should be familiar with the range of hemostatic agents available and their application during different types of bleeding
episodes. Bleeding complications can occur in healthy as well as systemically compromised patients. Having a broad knowledge of the management
approaches will allow the clinician to know when to apply a particular approach. Unfortunately, some of the most useful preventive measures and
management techniques are not utilized because of a lack of understanding of the coagulation process and/or the approaches and materials that are
available. The purpose of this article is to review the literature regarding the applications of various local hemostatic agents in the management of
bleeding in oral surgery, their mechanism of action, and contraindications. Furthermore, the novel hemostatic agents such as HemCon dental dressing
and Quikclot are also discussed. Local hemostatic agents are very useful in controlling bleeding during oral surgical procedures in patients with
congenital and acquired bleeding disorders and also in patients who are on antithrombotic medications for their systemic conditions.
Keywords: Hemostasis, Local hemostatic agents, Oral surgery, Bleeding.

Author Biography

Santhosh Kumar, saveetha dental college, saveetha university, chennai, india

oral and maxillofacial surgery



1. Ogle OE, Swantek J, Kamoh A. Hemostatic agents. Dent Clin North
Am 2011;55:433-9.
2. Kamoh A, Swantek J. Hemostasis in oral surgery. Dent Clin North Am
3. Brodbelt AR, Miles JB, Foy PM, Broome JC. Intraspinal oxidised
cellulose (surgical) causing delayed paraplegia after thoracotomy: A
report of three cases. Ann R Coll Surg Engl 2002;84(2):97-9.
4. McCarthy JR. Methods for assuring surgical hemostasis. In:
Rothrock JC, Seifert PC, editors. Assisting in Surgery: Patient-Centered
Care. Denver, CO: CCI; 2009. p. 137-94.
5. Samudrala S. Topical hemostatic agents in surgery: A surgeon’s
perspective. AORN J 2008;88(3):S2-11.
6. Schreiber MA, Neveleff DJ. Achieving hemostasis with topical
hemostats: Making clinically and economically appropriate decisions
in the surgical and trauma settings. AORN J 2011;94(5):S1-20.
7. Hoogerwerf BJ. Provide hemostasis. In: Phippen ML, Ulmer BC,
Wells MP, editors. Competency for Safe Patient Care during Operative
and Invasive Procedures. Denver, CO: CCI; 2009. p. 599-32.
8. Ogle OE. Perioperative hemorrhage. In: Dym H, Ogle OE, editors.
Atlas of Minor Oral Surgery. Philadelphia, PA: W.B. Saunders; 2000.
p. 62-3.
9. Andreoli TE, Bennett JC, Carpenter CC, Plum F. Platelets and primary
hemostasis. In: Andreoli TE, Bennett JC, Carpenter CC, Plum F, editors.
Cecil Essentials of Medicine. 4
ed. Philadelphia, PA: WB Saunders;
1997. p. 403.
10. CollaPlug [package insert]. Plainsboro, NJ: Integra Life Sciences
Corp.; 2001.
11. Loescher AR, Robinson PP. The effect of surgical medicaments on
peripheral nerve function. Br J Oral Maxillofac Surg 1998;36(5):327-32.
12. Qin-Shang Z, Qing-Zhong. Application of S-99 soluble styptic
gauze to wounds. Beijing Xuan Wu Hospital, Departments of
Pathology and Stomatology. Beijing, China Personal Communication;
December 31, 1982.
13. Data on file. Salt Lake City, Utah: Nelson Laboratories, Inc.; 2012.
14. Spotnitz WD, Burks S. Hemostats, sealants, and adhesives: Components
of the surgical toolbox. Transfusion 2008;48(7):1502-16.
15. Szpalski M, Gunzburg R, Sztern B. An overview of blood-sparing
techniques used in spine surgery during the perioperative period. Eur
Spine J 2004;13 Suppl 1:S18-27.
16. Ward BB, Smith MH. Dentoalveolar procedures for the anticoagulated
patient: Literature recommendations versus current practice. J Oral
Maxillofac Surg 2007;65(8):1454-60.
17. Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S.
Asian J Pharm Clin Res, Vol 9, Issue 3, 2016, 35-41
In vitro antimicrobial activity of oxidized regenerated cellulose
against antibiotic-resistant microorganisms. Surg Infect (Larchmt)
18. Pototski M, Amenábar JM. Dental management of patients receiving
anticoagulation or antiplatelet treatment. J Oral Sci 2007;49(4):253-8.
19. Tomizawa Y. Clinical benefits and risk analysis of topical hemostats: A
review. J Artif Organs 2005;8(3):137-42.
20. Wagner WR, Pachence JM, Ristich J, Johnson PC. Comparative in vitro
analysis of topical hemostatic agents. J Surg Res 1996;66(2):100-8.
21. Armstrong JK, Han B, Kuwahara K, Yang Z, Magyar CE, Dry SM,
et al. The effect of three hemostatic agents on early bone healing in an
animal model. BMC Surg 2010;10:37.
22. Spotnitz WD, Burks S. State-of-the-art review: Hemostats, sealants, and
adhesives II: Update as well as how and when to use the components of
the surgical toolbox. Clin Appl Thromb Hemost 2010;16(5):497-514.
23. Spotnitz WD, Burks S. Hemostats, sealants, and adhesives III: A new
update as well as cost and regulatory considerations for components of
the surgical toolbox. Transfusion 2012;52(10):2243-55.
24. Achneck HE, Sileshi B, Jamiolkowski RM, Albala DM, Shapiro ML,
Lawson JH. A comprehensive review of topical hemostatic agents:
Efficacy and recommendations for use. Ann Surg 2010;251(2):217-28.
25. Davis BR, Sándor GK. Use of fibrin glue in maxillofacial surgery.
J Otolaryngol 1998;27(2):107-12.
26. Malmquist JP, Clemens SC, Oien HJ, Wilson SL. Hemostasis of oral
surgery wounds with the HemCon Dental Dressing. J Oral Maxillofac
Surg 2008;66(6):1177-83.
27. Burkatovskaya M, Tegos GP, Swietlik E, Demidova TN, P Castano
A, Hamblin MR. Use of chitosan bandage to prevent fatal infections
developing from highly contaminated wounds in mice. Biomaterials
28. Dailey RA, Chavez MR, Choi D. Use of a chitosan-based hemostatic
dressing in dacryocystorhinostomy. Ophthal Plast Reconstr Surg
29. Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report
on the chitosan-based hemostatic dressing: Experience in current
combat operations. J Trauma 2006;60(3):655-8.
30. Aldridge E, Cunningham LL Jr. Current thoughts on treatment of
patients receiving anticoagulation therapy. J Oral Maxillofac Surg
31. Thatte HS, Zagarins S, Khuri SF, Fischer TH. Mechanisms of
poly-N-acetyl glucosamine polymer-mediated hemostasis: Platelet
interactions. J Trauma 2004;57 Suppl 1: S13-21.
32. Thatte HS, Zagarins SE, Amiji M, Khuri SF. Poly-N-acetyl glucosaminemediated
blood cell interactions. J
33. Schwaitzberg SD, Chan MW, Cole DJ, Read M, Nichols T, Bellinger D,
et al. Comparison of poly-N-acetyl glucosamine with commercially
available topical hemostats for achieving hemostasis in coagulopathic
models of splenic hemorrhage. J Trauma 2004;57 Suppl 1: S29-32.
34. Jensen DM, Machicado GA, Hirabayashi K. Randomized double-blind
studies of polysaccharide gel compared with glue and other agents for
hemostasis of large veins and bleeding canine esophageal or gastric
varices. J Trauma 2004;57 Suppl 1: S33-7.
35. Najjar SF, Healey NA, Healey CM, McGarry T, Khan B, Thatte HS,
et al. Evaluation of poly-N-acetyl glucosamine as a hemostatic
agent in patients undergoing cardiac catheterization: A double-blind,
randomized study. J Trauma 2004;57 Suppl 1: S38-41.
36. Connolly RJ. Application of the poly-N-acetyl glucosamine-derived
rapid deployment hemostat trauma dressing in severe/lethal Swine
hemorrhage trauma models. J Trauma 2004;57 Suppl 1: S26-8.
37. Klokkevold PR, Fukayama H, Sung EC, Bertolami CN. The effect
of chitosan (poly-N-acetyl glucosamine) on lingual hemostasis in
heparinized rabbits. J Oral Maxillofac Surg 1999;57(1):49-52.
38. Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, et al.
QuikClot use in trauma for hemorrhage control: Case series of 103
documented uses. J Trauma 2008;64(4):1093-9.
39. Alam HB, Chen Z, Jaskille A, Querol RI, Koustova E, Inocencio R,
et al. Application of a zeolite hemostatic agent achieves 100%
survival in a lethal model of complex groin injury in Swine. J Trauma
40. Carter G, Goss A. Tranexamic acid mouthwash: A prospective
randomized study of a 2-day regimen vs. 5-day regimen to prevent
postoperative bleeding in anticoagulated patients requiring dental
extractions. Int J Oral Maxillofac Surg 2003;32(5):504-7.
41. Carter G, Goss A, Lloyd J, Tocchetti R. Tranexamic acid mouthwash
versus autologous fibrin glue in patients taking warfarin undergoing
dental extraction: A randomized prospective clinical study. J Oral
Maxillofac Surg 2003;62(12):1432-5.
42. Kaewpradub P, Apipan B, Rummasak D. Does tranexamic acid in an
irrigating fluid reduce intraoperative blood loss in orthognathic surgery:
A double blind randomized clinical trial. J Oral Maxillofac Surg
43. Ramström G, Sindet-Pedersen S, Hall G, Blombäck M, Alander U.
Prevention of postsurgical bleeding in oral surgery using tranexamic
acid without dose modification of oral anticoagulants. J Oral Maxillofac
Surg 1993;51(11):1211-6.
44. Choi WS, Irwin MG, Samman N. The effect of tranexamic acid on
blood loss during orthognathic surgery: A randomized controlled trial.
J Oral Maxillofac Surg 2009;67(1):125-33.
45. Sindet-Pedersen S, Ramström G, Bernvil S, Blombäck M. Hemostatic
effect of tranexamic acid mouthwash in anticoagulant-treated patients
undergoing oral surgery. N Engl J Med 1989;320(13):840-3.
46. Majumder K, Shalender S, Rao JK, Gehlot N, Arya V, Siwach V.
Efficacy of haemocoagulase as a topical haemostatic agent after
minor oral surgical procedures: A prospective study. Int J Clin Med
47. Gibbs L, Kakis A, Weinstein P, Conte JE Jr. Bone wax as a risk factor
for surgical-site infection following neurospinal surgery. Infect Control
Hosp Epidemiol 2004;25(4):346-8.
48. Allison RT. Foreign body reactions and an associated histological
artefact due to bone wax. Br J Biomed Sci 1994;51(1):14-7.
49. Doonquah L, Mitchell AD. Oral surgery for patients on anticoagulant
therapy: Current thoughts on patient management. Dent Clin North Am
50. Wellisz T, An YH, Wen X, Kang Q, Hill CM, Armstrong JK. Infection
rates and healing using bone wax and a soluble polymer material. Clin
Orthop Relat Res 2008;466(2):481-6.
51. Bornert F, Gros CI, Schmittbuhl M, Manière MC. Hemostatic
management in pediatric patients with type I von Willebrand disease
undergoing oral surgery: Case report and literature review. J Oral
Maxillofac Surg 2011;69(8):2086-91.
52. Peisker A, Raschke GF, Schultze-Mosgau S. Management of dental
extraction in patients with haemophilia A and B: A report of 58
extractions. Med Oral Patol Oral Cir Bucal 2014;19(1):e55-60.
53. Bajkin BV, Urosevic IM, Stankov KM, Petrovic BB, Bajkin IA. Dental
extractions and risk of bleeding in patients taking single and dual
antiplatelet treatment. Br J Oral Maxillofac Surg 2015;53(1):39-43.
54. Verma G, Tiwari AK, Chopra S. Aspirin and exodontia: A comparative
study of bleeding complications with aspirin therapy. Int J Dent Sci Res
55. Olmos-Carrasco O, Pastor-Ramos V, Espinilla-Blanco R, Ortiz-Zárate A,
García-Avila I, Rodríguez-Alonso E, et al. Hemorrhagic complications
of dental extractions in 181 patients undergoing double antiplatelet
therapy. J Oral Maxillofac Surg 2015;73(2):203-10.
56. Girotra C, Padhye M, Mandlik G, Dabir A, Gite M, Dhonnar R, et al.
Assessment of the risk of haemorrhage and its control following
minor oral surgical procedures in patients on anti-platelet therapy: A
prospective study. Int J Oral Maxillofac Surg 2014;43(1):99-106.
57. Hanken H, Tieck F, Kluwe L, Smeets R, Heiland M, Precht C, et al.
Lack of evidence for increased postoperative bleeding risk for dental
osteotomy with continued aspirin therapy. Oral Surg Oral Med Oral
Pathol Oral Radiol 2015;119(1):17-9.
58. Nooh N. The effect of aspirin on bleeding after extraction of teeth.
Saudi Dent J 2009;21(2):57-61.
59. van Diermen DE, van der Waal I, Hoogstraten J. Management
recommendations for invasive dental treatment in patients using oral
antithrombotic medication, including novel oral anticoagulants. Oral
Surg Oral Med Oral Pathol Oral Radiol 2013;116(6):709-16.
60. Broekema FI, van Minnen B, Jansma J, Bos RR. Risk of bleeding after
dentoalveolar surgery in patients taking anticoagulants. Br J Oral and
Maxillofac Surg 2014;52(3):e15-9.
61. Bajkin BV, Bajkin IA, Petrovic BB. The effects of combined oral
anticoagulant-aspirin therapy in patients undergoing tooth extractions:
A prospective study. J Am Dent Assoc 2012;143(7):771-6.
62. Morimoto Y, Niwa H, Minematsu K. Risk factors affecting
postoperative hemorrhage after tooth extraction in patients receiving
oral antithrombotic therapy. J Oral Maxillofac Surg 2011;69(6):1550-6.
63. Zhao B, Wang P, Dong Y, Zhu Y, Zhao H. Should aspirin be stopped
before tooth extraction? A meta-analysis. Oral Surg Oral Med Oral
Pathol Oral Radiol 2015;119(5):522-30.
64. Napenas JJ, Hong CH, Brennan MT, Furney SL, Fox PC, Lockhart PB.
The frequency of bleeding complications after invasive dental treatment
in patients receiving single and dual antiplatelet therapy. J Am Dent
Assoc 2009;140(6):690-5.
65. Lillis T, Ziakas A, Koskinas K, Tsirlis A, Giannoglou G. Safety of dental
Asian J Pharm Clin Res, Vol 9, Issue 3, 2016, 35-41
extractions during uninterrupted single or dual antiplatelet treatment.
Am J Cardiol 2011;108(7):964-7.
66. Malmquist JP. Complications in oral and maxillofacial surgery:
Management of hemostasis and bleeding disorders in surgical
procedures. Oral Maxillofac Surg Clin North Am 2011;23(3):387-94.
67. Morimoto Y, Niwa H, Minematsu K. Hemostatic management of tooth
extractions in patients on oral antithrombotic therapy. J Oral Maxil
631 Views | 10498 Downloads
How to Cite
Kumar, S. “LOCAL HEMOSTATIC AGENTS IN THE MANAGEMENT OF BLEEDING IN ORAL SURGERY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 9, no. 3, May 2016, pp. 35-41, https://innovareacademics.in/journals/index.php/ajpcr/article/view/11744.
Review Article(s)

Most read articles by the same author(s)