Two Letters Re: Questions on Blood Clotting Agents

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