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Two Letters Re: Questions on Blood Clotting Agents
James:
See this
link for a PDF that provides a short article by two medical doctors concerning
the different clotting agents. Anyone contemplating a [blood clotting agent]
purchase should read the
article. - Bill N.
Dear Mr. Rawles,
I may be “just a dentist,” but hopefully I can offer some insight
into the gentleman’s question regarding ferric sulfate as a coagulant.
He is correct that it is a coagulant. I use it every day in a 15.5% aqueous solution
to control minor intraoral bleeding (modern dental impression
materials and tooth
colored filling materials don’t do well in the presence of moisture, especially
blood, during initial placement). Aluminum chloride solutions also work, but
not as well. Now keep in mind that I am typically using these products to control
bleeding gums around a tooth or a few teeth prepared for crowns where a little
bleeding of the gums is generally inevitable. If a patient has very unhealthy
gums there can be quite a bit of bleeding and these products can have a little
trouble in those situations. Now keep in mind we are only talking about capillary
(as opposed to arterial or venous bleeding of more traumatic injuries) around
a tooth. I have used these products for minor extraoral cuts on myself also,
not that a Band-Aid wouldn’t have worked (think shaving cuts!). Also it
has to be “burnished” into the wound to work effectively. So thinking
of the small surface areas and typical time for effect (1-2 minutes) that I am
dealing with, it doesn’t seem practical to try and control larger amounts
of bleeding with this technique.
In my experience (and observation of major oral and general surgery during
my Air Force residency), electrocautery like the soldering iron used in Patriots
(or laser cautery as I sometimes use in my practice), suturing, direct pressure,
indirect pressure, elevation and other traditional methods are much more effective
for more extensive bleeding.
Before replying I also did a quick search and noticed that ferric chloride
is used to create thrombi experimentally in lab animals (simulating clogged
arteries). Thrombi that break free are emboli. Emboli are potentially deadly
(think brain or lung emboli[sm]). You definitely don't want
to do that to your patient in a survival situation. These ferric solutions
do
create some
chunky coagulum even in the minor bleeding situations I deal with. In a more
serious traumatic injury I could envision a chunk entering a vessel and creating
an embolus.
I hope this helps and I hope a trauma surgeon or emergency room doctor reads
the blog and can add to or refute what I have stated. Thanks for your great
blog,
-
Joe,
DMD
