Presented by

Sidra Tul Muntaha

Demonstrator OMFS.

MANAGEMENT OF POST-OP
BLEEDING

Case Report
Name: M.Ubaid
Age: 6 years
Gender: Male
Address: Islamabad
P/C: pain in upper right and
lower left side of the face
Diagnosis: Rampant caries
Treatment: extractions
under GA.

Local Measures for Bleeding

Control
Locally-acting hemostatic agents work by
causing vasoconstriction or promoting
platelet aggregation.

Pressure packs .
Electrocautery.
Suturing and ligation.
Hemostat.
Hemostatic agents.

Pressure with oral packs

Electrocautery

Suturing/ligation

Hemostat.

Hemostatic agents
They are used for bleeding control and for
wound protection.
Gel foam.
Surgicel.
Bone wax.
Collagen.
Thrombin.

Gelfoam
A sterile, pliable, surgical sponge

prepared from purified gelatin

solution.
When implanted in tissues, the

sponge is completely absorbed within

four to six weeks without inducing
excessive scar tissue.
Provide scaffold for the formation of

blood clot.

Surgicel(resorbable oxidized regenerated cellulose

material).
It is prepared as a sterile fabric
meshwork.
Its mechanism of action is not
completely known, but appears to be
physical rather than involve an alteration

of the clotting mechanism.

After it is fully absorbed with blood, it
swells into a brownish/black gelatinous
mass that aids in clotting. Surgicel is
bacteriostatic and absorbs in 12 weeks.

Bone wax
Bone Wax is a sterile mixture of
beeswax, paraffin, and isopropyl
palmitate.
It is useful when bleeding is from a
visualized local vascular channel within

bone.
The wax is pliable enough to be placed
within a vascular channel, immediately
tamponading the vascular source.
Bone Wax is absorbable in 30 days.

Collagen
These products (eg, CollaPlug, CollaTape,
and Helistat) are soft, white sponge-like
structures.
They are fabricated from bovine collagen
and are nontoxic and nonpyrogenic.

Causes platelet aggregation and

accelerate clotting mechanism.
These products should be held in place
for approximately 2 to 5 minutes to
achieve hemostasis and then may be

removed, replaced, or left in situ.

All of these collagen materials are
completely resorbed within 14 to 56 days.

Thrombin
Liquid preparation of topical

thrombin can be saturated

onto gelatin sponge and
inserted into the tooth
socket.
Bovine origin.
The thrombin bypasses the

steps in the coagulation

cascade and helps to convert
fibrinogen to fibrin
enzymatically , which forms a
clot.

Systemic measures to control

bleeding
Systemic drugs work by inhibiting fibrinolysis or
promoting coagulation
Tranexamic acid.
Vitamin K.

Tranexamic acid

Tranexamic acid is a
synthetic derivative of the
amino acid lysine that exerts its
antifibrinolytic effect through
the reversible blockade of lysine
binding sites on plasminogen
molecules.

Intravenously administered
tranexamic acid (most
commonly 10 mg/kg followed
by infusion of 1 mg/kg/hour)

The competitive inhibition produced as tranexamic acid binds to

plasminogen makes it impossible for plasminogen to bind with
fibrin.

Vitamin K
Vitamin k is required for synthesis of clotting

factor II, VII, IX, X.

Vitamin K
Factor II
(prothrombin) is
converted into
thrombin during
clotting and results

in clot formation.

Vitamin K

 If bleeding still persist then you should rule

out for systemic causes.

Systemic causes
Hemophilia
Von Willebrands disease
Thrombocytopenia
Vitamin K deficiency
Disseminated intravascular coagulation

References

Contemporary oral and maxillofacial surgery.

Medical problems in dentistry by Scully.
Textbook of medical physiology by Guyton & Hall
Tranexamic acid: a review of its uses in surgery &
other indications Dunn CJ, Goa KL.
Etiology, Prevention and Management of Post
Extraction Complications
Continuing Dental Education Course - 4 CEUs
Author Michael Florman, DDS

Review of Hemostatic agents in dentistry

Written by William L. McBee, DDS, and Karl R. Koerner, DDS, MS
Tuesday, 01 March 2005 00:00

Acknowledgement
Dr. Mamoona Ahmed

THANK YOU