Review Article
Topical hemostatic agents from an oral-surgery perspective

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Abstract

Effective hemostasis is a major goal in any oral and maxillofacial surgical procedure. Uncontrolled hemorrhage can pose life-threatening consequences to the patient. When the conventional hemostasis methods are inadequate, the topical hemostatic agents play an important role as useful adjuncts to prevent further bleeding. Understanding the application, the mechanism of action, as well as the potential of the topical hemostatic agents, and having an insight on the limitations and undesirable effects will be useful in choosing the appropriate agent for each situation. The objective of this article is to go through some of the currently used agents, their applications, and some important points to keep in mind when utilizing these agents to manage cases with bleeding following surgical procedures in the oral and maxillofacial region.

Introduction

Perioperative bleeding is a major concern in any surgical procedure, especially in the head and neck region where the area is rich with extensive blood supply. Uncontrolled hemorrhage can compromise surgical outcomes or even lead to life-threatening outcomes. In oral surgery, most of the bleeding instances can be successfully controlled by applying pressure. On the other hand, when performing a major oral and maxillofacial surgical procedure which holds a higher risk of significant hemorrhage, pressure may not be sufficient, and bleeding needs to be controlled to with additional methods, such as electrocautery or vessel ligation. However, in some situations when applying pressure is ineffective and the employment of electrosurgical equipment may put the surrounding nerves or teeth in danger, topical hemostatic agents become beneficial [1]. Therefore, in order to achieve effective hemostasis in such cases, having a foundation on the hemostasis process, understanding the application of the topical hemostatic agents and their best usage, as well as their potential becomes essential for the oral surgeon to determine the most suitable agent for each case scenario [2].

Section snippets

Hemostasis process [3,4]

Hemostasis is a complex physiological set of events that stops blood loss at the damaged site. The hemostasis process involves vasoconstriction, development of a platelet plug, and the coagulation cascade, which is mainly when the blood clots.

Hemostatic collagen

Hemostatic collagen or Microfibrillar collagen is acquired from bovine skin collagen. It is nontoxic and nonpyrogenic [5]. It serves as a matrix that forms the clot and provides its strength. In addition, it enhances platelet aggregation, degranulation, and the release of clotting factors such as thromboxane A2 [6,7]. Microfibrillar collagen is available as powder or sheets (Avitene®), in plugs form (CollaPlug®), and in sheets form (CollaTape®). When exposing microfibrillar collagen to fluids,

Discussion

Perioperative hemorrhage is one of the major concerns in oral and maxillofacial surgery. In most cases, conventional hemostasis methods such as direct pressure, electrocautery, or vessel ligation can effectively control the bleeding in the oral and maxillofacial region [8]. However, in some situations, the application of topical hemostatic agents may be required as a useful adjunct [1].

In order to select the appropriate topical hemostasis agent for each situation, the surgeon should consider

Conclusion

It is important to emphasize that understanding the method of application, efficacy, as well as the disadvantages and the possible drawbacks of the common agents is essential in selecting the appropriate agent according to every case and avoiding the misuse of any of those elements, thus, converting its benefit into an unwanted side effect. The authors also believe that further studies may still be necessary on patients undergoing coagulation therapy and who are under long term anti-vitamin K

Declaration of Competing Interest

The authors declare no conflicts of interest.

Acknowledgements

None

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