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Bleeding Disorders Shalu Rai et al

Electrosurgery- Here heating occurs by induction from an unit of it is administered it raises the platelet count by
alternating current source. It is used in small arteries where it 7,000-10,000cells per cu mm.
can be applied after catching the bleeding point with a Fresh Frozen Plasma- 1 Unit (150ml) of FFP contains
haemostat. 220 u of factor VIII & IX and 400mg of fibrinogen.
Cryosurgery- temperature ranging from -20˚C to -180˚C are Cryoprecipitate- It is the only adequate fibrinogen
used which causes cryogenic necrosis of tissues, capillaries, concentrate available for intravenous use. A 15 ml vial
small arteries, venules. contains 100u factor VII, 250mg fibrinogen, factor XIII
Argon beam coagulator- A new form of electrocautery which &VWF.
allows bleeding to be controlled from vessels which are less Adrenochrome Monosemicarbazon And Ethamsylate
than 3 mm in diameter without having to use haemostats or
ligatures
BRAND NAME GENERIC NAME OR
DESCRIPTION
Local measures 1,3,6
Gelfoam (Pfizer, Markham, Absorbant gelatin sponge
Minimize trauma (e.g., elective sectioning of difficult Ont.) material
extractions, limiting the number of teeth to be removed at a Bleed-X (QAS, Orlando, Microporous polysaccharide
Fla.) hemispheres
time depending on the severity of the bleeding defect). Avoid
Surgicel (Ethicon, Markham, Oxidized cellulose
flaps, as they provide a much greater bleeding area that is Ont.)
harder to control with local measures. Choose surgical Tisseel (Baxter, Mississauga, Fibrin sealant
techniques that permit easy access for packing, suturing and Ont.)
Thrombostat (Pfizer) Topical thrombin
cautery. Strive to obtain primary surgical closure. Remove all Cyklokapron (Pfizer) Tranexamic acid
granulation tissue from areas of chronic inflammation. Various Amicar (Wyeth Markham, Epsilon-aminocaproic acid
adjuncts to hemostasis can be employed at the surgical site to Ont.)

enhance hemostasis, aid in vascular closure and prevent clot
breakdown. Table 2: Local hemostatic agents 1,7
Gelfoam is an absorbable gelatin sponge material that holds
many times its weight in blood and provides a stable “scaffold” In patients with hemophilia, additional postoperative
for clot formation. factor maintenance may be required after extensive
Astringents and styptics – Monsel’s solution and Tannic acid surgeries or infusion, DDAVP, cryoprecipitate or fresh
can be used which acts by precipitating proteins and clot frozen plasma depending on the patient’s condition.
formation. Other agents which can be used are silver nitrate, The patient’s hematologist should be consulted before
ferric chloride and Mann hemostatic (mixture of tannic acid, planning, and patients with severe disease should be
alum and chlorobutamol). Styptic is a substance used as an treated in specialty centres.
astringent, often to control bleeding. A chemical styptic induces Topical fibrin glue can reduce the amount of factor
coagulation of blood. A cotton pledget used as a compress to replacement needed when used along with
control bleeding is a mechanical styptic. antifibrinolytic agents.Fibrin glue has also been
Bleed-X is a hemostatic product containing “microporous effectively used in conjunction with other hemostatic
polysaccharide hemispheres” (potato starch) that dehydrate agents. 7,8
blood and accelerate clotting. It can be applied to all types of
surgical sites, including tooth sockets. Periodontal Procedures 1,7-9
Tisseel is a fibrin sealant that acts both through its adhesive Periodontal health is of critical importance in patients
action and by direct contribution of fibrin to clot formation. with bleeding disorders as inflamed and hyperemic
Cyklokapron (tranexamic acid) has also been used successfully gingival tissues are at increased risk of bleeding.
in the form of a mouthwash after oral surgical procedures to Periodontitis may cause tooth mobility and warrant
inhibit postoperative bleeding episodes. extraction, which may be a complicated procedure in
Other agents include bone wax, thrombin, oxygel, surgicel, these patients. Patients with coagulopathies may
fibrin glue, adrenaline neglect their oral health due to fear of bleeding during
tooth brushing and flossing, which leads to increased
SYSTEMIC AGENTS 1,3,6,7,8 gingivitis, periodontitis and caries.
Whole blood- It contains all the factors for coagulation. It’s used Periodontal probing, supragingival scaling and
when specific blood components are not available. It’s polishing can be done normally without the risk of
administered within 24 hrs of its donation. significant bleeding. Factor replacement is seldom
Platelet Rich Plasma- derived from autologous blood and is needed for subgingival scaling and root planing if these
defined as a certain volume of plasma that has a platelet procedures are done carefully. Ultrasonic
concentration several fold above the physiologic levels. One instrumentation may result in less tissue trauma. For

Journal of Oral Sign 2011, Vol 3, No 2 (May-Aug)