Effective control of hepatic bleeding with a novel collagen-based composite combined with autologous plasma: results of a randomized controlled trial. Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery. Effective management of bleeding during tumor resection with a collagen-based hemostatic agent. Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions. Evaluation of the Hemostatic Effects of Ankaferd Blood Stopper During Dental Extractions in Patients on Antithrombotic Therapy Assessment of hemostatic efficacy and osseous wound healing using HemCon dental dressing. Comparison of a new fibrin sealant with standard topical hemostatic agents. Effect of aluminum chloride hemostatic agent on microleakage of class V composite resin restorations bonded with all-in-one adhesive Hemostasis Control in Dental Extractions in Patients Receiving Oral Anticoagulant Therapy: An Approach With Calcium Sulfate Prospective, randomized clinical trial of the FloSeal matrix sealant in cardiac surgery. Upper gastrointestinal bleeding Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. Hemostasis in endoscopic sinus surgery using a specific gelatin-thrombin based agent (FloSeal). TC‐325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high‐risk bleeding stigmata: A randomized pilot study Randomized, prospective trial comparing bridging therapy using low-molecular-weight heparin with maintenance of oral anticoagulation during extraction of teeth.
HYPOTHESIS A novel collagen-based composite of bovine microfibrillar collagen and bovine thrombin combined with autologous plasma is more effective than st and ard hemostasis ( collagen sponge applied with pressure ) in controlling diffuse hepatic bleeding  after hemihepatectomy or segmental resection of the liver . DESIGN R and omized controlled trial . SETTING Seven university-affiliated medical centers . PATIENTS Sixty-seven adult patients scheduled for hemihepatectomy or segmental resection who received hemostatic intervention with an investigational treatment ( n = 38 ) or control ( n = 29 ) . INTERVENTION Bleeding hepatic tissue was managed in all control subjects with a collagen sponge with manual pressure . Subjects in the experimental group had the sprayable liquid composite intraoperatively applied to the surgical site . The liquid immediately formed a collagen-fibrin gel that was used without concomitant tamponade . MAIN OUTCOME MEASURES Hemostatic success was defined as the proportion of subjects in each treatment group who achieved complete hemostasis within 10 minutes . Success rates and median times required to achieve controlled bleeding ( ie , slight oozing ) and complete hemostasis were compared between treatment groups . RESULTS All 38 subjects in the experimental group achieved complete hemostasis within 10 minutes compared with only 69 % ( 20/29 ) of control subjects ( P<.001 ) . The median time to controlled bleeding was approximately 4 times longer ( 250 vs 62 seconds ) for control subjects than for experimental group subjects ( P<.001 ) . The median time required to achieve complete hemostasis also favored the experimental group ( 150 vs 360 seconds ; P<.001 ) . No adverse events related to the use of the experimental hemostatic agent were detected . CONCLUSIONS The experimental composite is more effective at controlling and stopping diffuse hepatic bleeding than a collagen sponge applied with pressure ; it may be a useful hemostatic agent for patients undergoing hemihepatectomy , segmental resection , and related surgical procedures The hemostatic efficacy , as well as the cardiovascular effects , of two hemostatic agents currently used during endodontic surgery was examined . The hemostatic agents used were epinephrine pellets ( Racellet pellets ) or 20 % ferric sulfate ( Viscostat ) .  Patients were assigned to one of two experimental groups .  Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery ( root-end resection , root-end preparation , and filling ) . The adequacy of hemostasis was rated by the surgical operator . Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents . Except in one case where ferric sulfate was the agent , both agents produced surgical hemostasis that allowed for a dry field for root-end filling In a prospect i ve controlled trial hemostatic effectiveness of a novel collagen-based composite ( CoStasis ) was compared with a collagen sponge applied with manual pressure at diffusely bleeding sites after surgical tumor resection .  The proportion of subjects achieving complete cessation of bleeding within 10 minutes ( i.e. , hemostatic success ) and the time to " complete hemostasis " were determined at raw surgical sites after tumor resection among 23 experimental and 30 control subjects . There was a similar distribution in tumor types ( e.g. , benign vs malignant ) evaluated between treatment groups . A significantly greater proportion of experimental subjects achieved complete hemostasis within 10 minutes of observation compared with controls [ 23 of 23 ( 100 % ) vs 21 of 30 ( 70 % ) ; P = 0.003 ] . The median time required to achieve complete hemostasis was more than three times longer for subjects treated with the collagen sponge compared with subjects treated with CoStasis ( 243 vs 78 seconds ; P = 0.0001 ) . Approximately 80 per cent of experimental subjects achieved complete hemostasis within 2 minutes compared with only 35 per cent of controls . There were no adverse events related to the experimental treatment in this study . These results support the use of this novel hemostatic agent to control diffuse surgical site bleeding  after tumor resection at diverse anatomical locations BACKGROUND / AIM Patients receiving long-term oral anticoagulant therapy  pose a clinical challenge during invasive dental procedures . The goal of this study was to compare different local hemostatic modalities after tooth extraction in patients receiving chronic Vitamin-K antagonist therapy .  METHODS Totally 90 patients with International Normalized Ratio ( INR ) ≤ 3.0 requiring simple extraction of one or two teeth were r and omized into three groups , 30 patients in each group . The patients with the mean INR value of 2.35 ± 0.37 , in whom extraction wound was sutured comprised the group A. In the group B with the mean INR of 2.43 ± 0.4 , local hemostasis was achieved by placing absorbable gelatin sponges into the wound without suturing . The group C consisted of the patients with the mean INR of 2.36 ± 0.34 in whom neither gelatin sponge nor suturing were used for providing local hemostasis . Bleeding was registered as an event if other than initial hemostatic measure was needed or additional oral surgeon intervention required . RESULTS The obtainded results show that 1 ( 3.3 % ) patient in the group A , 2 ( 6.7 % ) patients in the groups B and C manifested post- extraction bleeding . All cases of hemorrhage were easily solved with local hemostatic measures and all , except one case , were registered in the first two hours after the procedure until the dismissal . A difference between the groups was not statistically significant ( χ2 = .42 , p > 0.05 ) . CONCLUSION In therapeutically anticoagulated patients tooth extraction s can be safely performed without altering the dose of anticoagulant medication if efficient local hemostasis is provided . In most cases ; in patients with INR ≤ 3.0 after extraction of one or two teeth postoperative bleeding can be controlled with local pressure , without any additional local hemostatic measures This study evaluated the early hemostatic effects of a novel hemostatic agent ( Ankaferd blood stopper [ ABS ] ) during dental extraction s in patients on antithrombotic therapy  , without interruption or diminution of the medication . In total , 25 patients , who are on antithrombotic therapy and in need of simple dental extraction s , were r and omized into 2 groups . In group I ( control group ) , which consisted of 10 patients , local hemostasis was achieved with direct packing with gauze . In group II , which consisted of 15 patients , local hemostasis was achieved by the local application of ABS on the extraction sockets . The bleeding time was compared between 2 groups following the tooth extraction . The bleeding time in the dental sockets treated with ABS was statistically lower compared to the sockets of the control group ( p = 0.0001 ) . It is concluded that the dental extraction s could be performed without interruption of the medication in patients on antithrombotic therapy . The ABS appears to be sufficient as an alternative hemostatic agent INTRODUCTION Obtaining hemostasis in the surgical crypt during periradicular surgery is essential . It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material . Although current material s may not be moisture sensitive during setting , hemostasis is important for proper placement of root-end filling material s during apical surgery . A new hemostatic agent , HemCon dental dressing ( Patterson Dental , St Paul , MN ) , may improve upon the efficacy of wound healing and hemostasis both in extent and time . The aim of this study was to evaluate the hemostatic effect of HemCon in osseous wound sites and evaluate the wound healing potential and percentage of new bone formation in osseous crypts treated with HemCon . METHODS A split-mouth design was used with r and om allocation of sham and experimental sites in 12 rabbits . In experimental sites , either HemCon or 15.5 % ferric sulfate was applied to osseous crypts created with a round bur . Hemostatic efficacy was evaluated using predetermined scores . Rabbits were sacrificed at 21 days , and tissues were harvested and prepared for histologic evaluation . A blinded pathologist scored sample s relative to inflammation . The percentage of new bone deposition was calculated using NIS Elements software ( Nikon Instruments Inc , Melville , NY ) . RESULTS There was no statistical significant difference in hemostatic efficacy or wound healing between HemCon and ferric sulfate ( P > .05 ) . The HemCon group showed a significantly higher percentage of new bone deposition compared with the controls ( P < .01 ) . CONCLUSIONS HemCon shows promise as an adjunct to the endodontic surgical armamentarium BACKGROUND Bleeding following liver resection continues to be a significant morbidity of the procedure . Fibrin sealants represent an improvement over conventional topical hemostatic agents , because they contain components that actively form clot . However , most available agents contain nonhuman protein , which represents an immunologic risk . HYPOTHESIS An investigational surgical fibrin sealant ( Crosseal ; American Red Cross , Washington , DC ) composed of human clottable proteins and human thrombin is more effective than st and ard topical hemostatic agents in reducing the time required to achieve hemostasis after liver resection . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Fifteen major referral centers in the United States and the United Kingdom . METHODS After liver resection using st and ard surgical techniques , 121 patients seen between May 1999 and May 2000 were r and omized to treatment with a 2-component fibrin sealant ( n=58 ) or to st and ard topical hemostatic agents , used singly or in combination ( n=63 ) . Up to 10 mL of Crosseal was administered by a spray applicator , as recommended by the manufacturer , whereas agents used in the control group were applied according to their instructions for use . MAIN OUTCOME MEASURES The primary outcome measured was time to hemostasis . Secondary outcomes measured included blood loss between application of the hemostatic agent and closure of the abdomen , duration of postoperative biliary drainage , and the occurrence of complications , defined a priori as reoperation for any reason , development of abdominal fluid collection s , or bilious appearance of drained fluid for at least 1 day postoperatively . RESULTS The mean time to hemostasis was 282 seconds with Crosseal , compared with 468 seconds with st and ard agents ( 2-sided ; P = .06 ) , for the 116 efficacy-evaluable patients .  Hemostasis was achieved within 10 minutes in 53 patients ( 91.4 % ) treated with the study fibrin sealant and in 44 control patients ( 69.8 % ) ( 2-sided ; P = .003 ) . Intraoperative blood loss was similar in the 2 groups . In the Crosseal group , the percentage of patients developing postoperative complications was 17.2 % , compared with 36.5 % in the control group ( 2-sided ; P = .02 ) . CONCLUSIONS Compared with the use of st and ard topical hemostatic agents , Crosseal fibrin sealant significantly reduced the time to achieve hemostasis following liver resection . Patients treated with the new fibrin sealant also experienced significantly fewer postoperative complications Objectives : Since hemostatic agents can induce changes on enamel and dentin surfaces and influence composite resin adhesion , the aim of the present study was to evaluate the effect of the aluminum chloride hemostatic agent on the gingival margin microleakage of class V ( Cl V ) composite resin restorations bonded with all-in-one adhesive . Study design : Cl V cavities were prepared on the buccal surfaces of 60 sound bovine permanent incisors . Gingival margins of the cavities were placed 1.5 mm apical to the cemento-enamel junction ( CEJ ) . The teeth were r and omly divided into two groups of 30 . In group 1 , the cavities were restored without the application of a hemostatic agent ; in group 2 , the cavities were restored after the application of the hemostatic agent . In both groups all-in-one adhesive and Z250 composite resin were used to restore the cavities with the incremental technique . After finishing and polishing , the sample s underwent a thermocycling procedure , followed by immersion in 2 % basic fuschin solution for 24 hours . The sample s were sectioned and gingival microleakage was evaluated under a stereomicroscope . The non-parametric Mann-Whitney U test was used to compare microleakage between the two groups . Statistical significance was defined at P<0.05 . Results : A statistically significant difference was observed in microleakage between the two groups ( P<0.001 ) . Conclusions : Contamination of Cl V composite resin restorations bonded with all-in-one adhesive with aluminum chloride hemostatic agent significantly increases restoration gingival margin microleakage . Key words : All-in-one adhesive resin , composite resin restoration , hemostatic agent , microleakage Abstract The aim of this study was to evaluate the use of calcium sulfate ( CaS ) as a hemostatic agent after tooth extraction in patients with anticoagulant drug therapy . A total of 30 patients undergoing anticoagulant therapy ( 22 women and 8 men ) with a mean age of 54.6 years ( SD = 9.2 years ) , needing dental extraction s , were selected for this study . They were divided into 2 groups , control ( group 1 ) and test ( group 2 ) , in a r and omized way . In group 1 patients , the post extraction socket was managed with obliterative suture only . Group 2 patients were treated with CaS placed into the post extraction sockets . All the patients did not interrupt the anticoagulant therapy during the dental treatment . The healing pattern was found to be approximately similar in all treatment groups , showing significant improvement at each consecutive visit . However , a statistically significant difference in the adequate hemostasis was evident between groups 1 and 2 ( P = 0.0056).The use of CaS helped to control the bleeding from inside the socket , producing instantly a very good hemostasis . Further studies are necessary to confirm the simplicity , possibilities , and limits of the proposed procedure BACKGROUND Topical hemostatic agents composed of a gelatin-based matrix and thrombin have been reported to be effective , in addition to traditional means , in terminating bleeding during cardiac operations . We compared a hemostatic matrix sealant agent ( FloSeal ; Baxter Inc , Deerfield , IL ) with alternative topical hemostatic agents in a mixed cohort of elective cardiac and thoracic aortic operations . METHODS Following sample size calculation , in a prospect i ve r and omized study design , 209 patients were treated with FloSeal matrix sealant ( FloSeal group ) and 206 patients received alternative agents as topical hemostatic material s ( comparison group ) . FloSeal is composed of a self-exp and able gelatin matrix component and purified bovine thrombin . Comparisons included hemostatic patches or sponges composed of either oxidized regenerated cellulose or purified porcine skin gelatin . Study endpoints were the following : rate of successful intraoperative hemostasis ( identified by cessation of bleeding ) and time required for hemostasis ; overall postoperative bleeding ; rate of transfusion of blood products ; rate of surgical revision for bleeding ; postoperative morbidity ; and intensive care unit stay . RESULTS Statistically higher rates of successful hemostasis and shorter time-to-hemostasis were observed in the FloSeal group ( p < 0.001 both ) . Time-to-event analysis confirmed this finding ( p = 0.0025 ) . Postoperative bleeding and rate of transfusion of blood products were statistically decreased in the FloSeal group ( p < 0.001 both ) . Rates of revision for bleeding and of minor complications were not statistically different among groups in the overall cohort , but were significantly lesser in the FloSeal group if only patients with overt intraoperative bleeding are considered ( p = 0.04 both ) . The advantages observed in the FloSeal group were not offset in patients undergoing systemic hypothermia . CONCLUSIONS The topical hemostatic agent used in the FloSeal group is effective in terminating intraoperative bleeding as an adjunct to traditional surgical methods for stopping bleeding . Its judicious use is associated with lesser need for transfusion of blood products and rate of revision for bleeding . Its cost-utility profile should be addressed in dedicated trials Purpose of review This review discusses key issues in the management of upper gastrointestinal bleeding including patient preparation , sedation , hemostatic techniques , disposition , and recommended pharmacologic interventions . Recent findings Optimal resuscitation before endoscopy and proper pharmacologic interventions after endoscopy seem to be as crucial to the management of patients with upper gastrointestinal bleeding as meticulous hemostatic techniques during the procedure . In a retrospective evaluation of patients with upper gastrointestinal bleeding , multivariate analysis demonstrated significantly reduced morbidity and mortality in those who underwent aggressive preendoscopic resuscitation . In a prospect i ve , r and omized clinical trial , patients who received intravenous proton pump inhibitor therapy after endoscopic intervention  had a significantly reduced rebleeding rate compared with their placebo control group . Summary The algorithms described in this review can be applied clinical ly today and should directly lead to improved outcome . Nevertheless , even with the latest care available , results are not optimal . This review points to two major areas where we can benefit from improvement : primary hemostasis and recurrent bleeding . By pointing to these limitations , it is hoped that this review can help stimulate research in the field by applying new technologies to solve these problems . Endoscopic ultrasound , for example , could be used to help identify feeding vessels that can be treated endoscopically , thus potentially decreasing the incidence of failed primary hemostasis .  Endoscopic suturing , when more fully developed , may provide a better hemostatic technique that can reduce the incidence of recurrent bleeding . It is only through these review s that our state of knowledge in the field can be constantly reevaluated to up date today 's clinician with the latest knowledge and stimulate tomorrow 's research ers with challenging problems Introduction Oral anticoagulants are widely prescribed drugs . Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy . The purpose of this study was to evaluate the incidence of bleeding complications after dental extraction s in patients on anticoagulant therapy ( warfarin ) in whom different local hemostatic methods were used . Material and methods Patients using warfarin and requiring extraction s of at least two teeth were screened to participate in this prospect i ve , r and omized study . Extraction sites were considered as sampling units ( statistically representative sample size ) and were allocated to one of the three study groups ( G1—4.8 % tranexamic acid ; G2—fibrin sponge ; and G3—no local hemostatic agents ) . Results Eighty-four extraction sites were obtained from patients with mitral valve prolapse ( 47.4 % ) , prosthetic cardiac valve ( 23.7 % ) , venous thromboembolism ( 21.1 % ) , and pulmonary embolism ( 5.2 % ) .  International normalized ratio ( INR ) values ranged between 2.1 and 3.1 ( mean 2.51 ± 0.1 ) . Postoperative bleeding was observed in four surgical sites ( p < 0.001 ) and was mainly in older patients ( p = 0.005 ) . Discussion The three local hemostatic protocol s were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin .  The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy OBJECTIVE To determine whether FloSeal Matrix Hemostatic Sealant is a safe and effective means of controlling bleeding  post-endoscopic sinus surgery ( ESS ) and to assess postoperative healing . DESIGN Prospect i ve clinical study . SETTING University of Toronto . METHODS Eighteen patients with FloSeal placed on a total of 30 operative sites post-ESS .  Time to cessation of bleeding was assessed intraoperatively . Patients had the operative sites assessed at 30 days postoperatively . MAIN OUTCOME MEASURES Effectiveness of FloSeal in controlling bleeding and aiding in healing of the operative site . RESULTS FloSeal adequately controls postoperative bleeding in patients post-ESS .  Healing was also not adversely affected . CONCLUSIONS FloSeal is a safe and effective treatment for controlling blood loss after EES . It may also provide support to the middle meatus as well as improve healing of the operative site compared with the use of traditional nasal packing . However , r and omized clinical trials are needed to further evaluate this We carried out a placebo-controlled , double-blind , r and omized study of the hemostatic effect of tranexamic acid mouthwash after oral surgery in 39 patients receiving anticoagulant agents because of the presence of cardiac valvular stenosis , a prosthetic cardiac valve , or a vascular prosthesis . Surgery was performed with no change in the level of anticoagulant therapy , and treatment with the anticoagulant agent was continued after surgery . Before it was sutured , the operative field was irrigated in 19 patients with 10 ml of a 4.8 percent aqueous solution of tranexamic acid ( an inhibitor of fibrinolysis ) and in 20 patients with a placebo solution . For seven days thereafter , patients were instructed to rinse their mouths with 10 ml of the assigned solution for two minutes four times a day . There were no significant differences between the two treatment groups in base-line variables , including the level of anticoagulation at the time of surgery . Eight patients in the placebo group had a total of 10 postoperative bleeding episodes , whereas only 1 patient in the tranexamic acid group had a bleeding episode ( P = 0.01 ) . There were no systemic side effects . We conclude that local antifibrinolytic therapy is effective in preventing bleeding after oral surgery in patients who are being treated with anticoagulants The safety and efficacy of a new hemostatic sealant , based on a gel with collagen derived particles and topical thrombin ( FloSeal , Fusion Medical Technologies , Inc. Fremont , CA ) were assessed as an alternative to nasal packing for hemostasis in functional endoscopic sinus surgery . In a prospect i ve clinical study of 50 patients undergoing bilateral endoscopic anterior ethmoidectomy  , 2 ml FloSeal was used after surgery to stop bleeding . The results were compared to a control group of 50 patients with Merocel packing  and showed that intraoperative hemostasis was rapid and equal in both groups . The main advantages of the new hemostatic sealant included a higher degree of comfort during postoperative nasal breathing and absence of complaints due to pressure or pain . There was only one case of postoperative bleeding on the 6th day , which required nasal packing . There were no more cases of stenoses or synechia in the ostiomeatal complex than were found in the Merocel group . No systemic side effects due to FloSeal were observed . This specific hemostatic sealant was shown to be a safe and efficacious alternative method for hemostasis in endoscopic sinus surgery with high patient satisfaction and an easy and fast mode of application Preliminary studies on a new topical hemostatic agent , TC‐325 , have shown its safety and effectiveness in treating active upper gastrointestinal ( GI ) bleeding . However , to date there have been no r and omized trials comparing TC‐325 with the conventional combined technique ( CCT ) . Our pilot study aim ed to compare the efficacy and safety of TC‐325 with those of CCT in treating peptic ulcers with active bleeding or high‐risk stigmata PURPOSE To evaluate postoperative bleeding and thromboembolic complications during dental extraction s in anticoagulated patients , using 2 different protocol s. PATIENTS AND METHODS In total , 214 anticoagulated patients in need of simple dental extraction s were r and omized into 2 groups . Group A consisted of 109 patients on continuous oral anticoagulation therapy ( OAT ) , with a mean international normalized ratio ( INR ) of 2.45 + /- 0.54 . Local hemostasis in these patients was achieved with resorbable collagen sponges , without wound suturing . Group B consisted of 105 patients on bridging therapy with low-molecular-weight heparin ( nadroparin-calcium ) , with a mean INR of 1.26 + /- 0.11 on the day of the procedure . Neither local hemostatic agents nor suturing of the wound was used in these patients . RESULTS Eight ( 7.34 % ) patients in group A and 5 ( 4.76 % ) patients in group B manifested post extraction al bleeding , without statistical significance ( chi(2 ) , Yates ' = 0.253 , P > .05 ) . All cases of hemorrhage were mild and easily controlled using local hemostatic measures . None of the participants in either group experienced thromboembolic complications . CONCLUSIONS In patients receiving OAT with an INR < or=4.0 , simple dental extraction s can be performed safely without interruption or modification of OAT , using local hemostatic measures . Suturing of the wound should be reserved for cases with a greater extent of surgical trauma , and when primary hemostasis is insufficient . There is no need for bridging therapy with low-molecular-weight heparin in patients undergoing minor dentoalveolar procedures , although this approach can be used in patients with major oral surgical interventions
Scanning electron microscopy revealed partial removal of the smear layer or an etching effect of dentin as a result of the application of hemostatic agents on dentin .
PRACTICAL IMPLICATION S Adhesive procedures may be affected adversely when performed on dentin and enamel contaminated by hemostatic agents .
Hemostatic agents may induce changes in the dentin surface morphology .
The results of this review indicate that the bond strength of self-etching adhesive systems is affected more negatively than is that of etch- and -rinse systems .
BACKGROUND Hemostatic agents have been used clinical ly in dentistry for many years to control bleeding .