A comparative evaluation of the effectiveness of chitosan-based dressing and conventional method of hemostasis in patients on oral antithrombotic therapy without therapy interruption

Abstract

Aims and Objectives: To assess the effectiveness of chitosan-based dressing after extraction in individuals on antithrombotics, without modification of their treatment schedule. Materials and Methods: A randomized comparative study was carried out on 40 subjects who had two extraction sites, in dissimilar quadrants. The surgical site was chosen at random and post-extraction hemostasis was achieved by a custom-cut chitosan dressing (study site) and sterile cotton gauze dressing (suturing if required) at control site. Patients were reviewed on the first, third, fifth, and seventh postoperative days and every week till 4 weeks. The parameters assessed were timing of hemostasis, pain scores, and pus discharge. Results: Out of 40 study subjects, 24 (60%) were males and 16 (40%) were females. The age was 40–65 years (mean age 54 years). The mean time for hemostasis was 0.63 ± 0.27 min in study group, whereas for controls, it was 9.10 ± 2.28 min. The difference in postoperative pain was significant ( P = 0.001) on days one, five, and seven. In chitosan group extraction sites, dry socket was not seen, whereas four patients on day three and five patients on day five after extraction experienced dry socket in pressure gauze dressings group, with an insignificant difference ( P = 0.058). In chitosan group extraction sites, no pus discharge was seen. Whereas four patients on days three and five after extraction had pus discharge in patients where pressure dressings were applied, with an insignificant difference ( P = 0.058). Conclusion: Chitosan dressing is a competent hemostatic agent that significantly reduced the post-extraction bleeding, with better pain control. Chitosan group had no incidences of dry socket and pus discharge.

Applications of Chitosan in Surgical and Post-Surgical Materials

“…Again, the efficacy of this material was compared to the use of cotton gauze dressings. Not only was the mean time for hemostasis significantly reduced with chitosan-based dressings, but the incidence of adverse events-dry socket and pus discharge-was also notably lower [169]. The combination of fibrin glue and chitosan dressings has also been explored to improve the hemostatic process in patients with hemophilia.…”

Thrombostatic Agents and Tissue Adhesives in the Emergency Department: Stopping the Bleeding, Closing the Wound, and Novel Applications

“…In a case series of 35 patients on antiplatelet agents or anticoagulants who failed initial management with cautery and nasal packing, 32 patients were successfully treated with application of a foam anterior pack wrapped in a chitosan sheet [20]. A small study of 40 patients on oral anticoagulation undergoing multiple tooth extractions compared a site treated with a chitosan pledget with a site treated with gauze and pressure and found decreased bleeding times and decreased postoperative pain in the chitosan treated site [21]. Another small study of 20 patients on oral anticoagulants undergoing dental extraction of multiple teeth found that the extraction sites treated with chitosan had shorter bleeding times than control extraction sites treated with a collagen matrix plug [22].…”

Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery

“…And the most widely used scaffolding agents are modified collagen, oxidized regenerated cellulose (ORC), absorbable gelatin, and chitosan dressing. [ 12 – 14 ]…”