Styptics

Sanjaya Mani Dixit

Contents
• Blood Clotting
• Coagulation Factors
• Coagulation Cascade
• Coagulants
• Styptics
• Hemostasis
• Astringents
Blood Clotting phases
 Injury to arterioles and smaller blood vessels
 Onset of normal hemostasis occurs
successively by contraction of injured vessel
wall (lasts few minutes)
 Adhesion and aggregation of platelets,
platelet plug formation
 Formation of blood clot
 Fibrinolysis: Breakdown of clot
Coagulation factors
Factor Name
I Fibrinogen

FiP TiC PAPA CP HF

II Prothrombin
III Tissue Factor or thromboplastin
IV Ca++
V Proaccelerin
VI Accelerin
VII Proconvertin
VIII Antihemophilic A factor
IX Christmas factor or Stuart-Prower factor
XI Plasma thomboplastin antecedent
XII Hageman factor
XIII Fibrin stabilizing factor

HMWK- High molecular weight kininogen

Stopping Bleeding
 External bleeding is usually stopped by
 Manual pressure
 Cotton-gauze pressure pack

 Suturing

Control of bleeding may be aided by local

hemostatics/ styptics- substances used to stop
bleeding from a local and approachable site
Coagulants
 The substances which promote coagulation, and
are indicated in hemorrhagic states.
 Clotting factor deficiency states- best treated with
fresh whole blood or plasma.

 Drugs used for coagulation purpose:

 Vitamin K1– Phytomenadione (Plants)
 Vitamin K2 –Menadione (GI bacteria)
 Tranexamic acid
 Ethamsylate
 Desmopressin
Styptics
 Styptics are a specific type of hemostatic
agents that work by contracting tissue to seal
injured blood vessels.
 They are particularly useful in oozing
surfaces:
 Tooth socket,
 abrasions, etc.
Styptics
 Fibrin (Prepared from human plasma and dried as
sheet or foam)
 Gelatin foam (Porcine or bovine gelatin)
 Oxidized cellulose (Strips which can be cut and
placed in the wound)
 Thrombin (Obtained from bovine plasma)
 Adrenaline applied locally
 Astringents like tannic acid, ferric chloride, Ferric
sulfate (concentrated forms)
Styptics
 Styptics like fibrin, gelatin foam and oxidized
cellulose provide a meshwork for activation of
clotting mechanisms and checks bleeding.
 Left in situ
 Get absorbed in 1-4 weeks times without causing
allergic reactions

 Thrombin may be applied as dry powder or freshly

prepared solution to the bleeding surface in
haemophiliacs.
Fibrin
 Obtained from human plasma
 Dehydrated form as sheets- cut to size
 When used in combination with thrombin solution,
acts as a mechanical barrier and holds thrombin in
position over the bleeding area.
Gel foam/sponge
 Porous pressed form of gelatin sponge
 Used in conjunction with thrombin to control oozing
of blood from surface wounds.
 Usually moistened with sterile, isotonic saline
before use
 Completely absorbed in 1- 4 weeks, when left in
place after suturing the wounds
 Available in different shapes and sizes
Oxidized cellulose
 Surgical gauze treated with nitrogen dioxide
 Promotes clotting by a reaction between cellulosic
acid and hemoglobin
 When wet with tissue fluids, oxidized cellulose
becomes sticky, gummy and offers mechanical
blockade which simulates an artificial clot over the
wound surface.
 Absorbed completely within 2-10 days
 Interferes with bone regeneration
Thrombin
 Obtained from bovine plasma
 Stable in dried powder form @ 2-8oC.
 Inactive below pH 5.
 Use restricted to local application in oozing of blood
 Also used, mixed with plasma, to anchor skin grafts
in place
Styptics- Vasoconstrictors
 Vasoconstrictors like 0.1% Adr solution may be
soaked in sterile cotton-gauze and packed in:
 bleeding tooth socket or

 nose in case of epistaxis

 to check bleeding when spontaneous

vasoconstriction is inadequate.

 Epinephrine (1:200,000/1:100,000/1:50,000),
 Levonordefrine (1:20,000) and
 Norepinephrine (1:30,000)
Hemostatic agents
 Hemostatic agents used in medicine are either:
 Systemic drugs: They work by inhibiting fibrinolysis or promoting
coagulation. These include antifibrinolytics (e.g., aminocaproic acid ),
vitamin K, fibrinogen, and blood coagulation factors

 Locally-acting
hemostatic agents (e.g., tannic and): They work by
causing vasoconstriction or promoting platelet aggregation

 Organic:As a kind of hybrid of local and systemic, topical hemostatic

bandage D-Stat Dry is medicated with thrombin coagulation factor:
D-Stat Dry is a topical hemostatic bandage used to control surface
bleeding from vascular access sites following percutaneous procedures. It
relies on clotting power of thrombin to activate clotting factors VII, V and
XII
Astringents
 Astringents are substances that precipitate
proteins, but do not penetrate cells and this affect
the superficial layer of mucosa only.
 Aluminum chloride and ferrous sulfate are preferred
astringents in dentistry since they cause minimum
tissue damage.
 Examples
 Alum
 Aluminium chloride
 Zinc chloride (8-20%)
 Tannic acid
Astringents
 Theword "astringent" is derived from Latin adstringere,
meaning "to bind fast".
 Definition: Astringent is a drug that reacts chemically with
cellular proteins producing limited coagulation which is
accompanied by shrinkage of body tissues.
 Astringent protects from external irritation and reduces
cellular permeability
 It also possesses local styptic and local antiseptic actions
 Examples:
 very cold water,
 rubbing alcohol and zinc oxide, and
 vegetable substances such as tannic acid
Astringents
 Astringentmedicines cause shrinkage of mucous
membranes or exposed tissues and are often used internally
to check discharge of blood serum or mucous secretions
 sore throat,
 hemorrhages,
 diarrhoea, or
 peptic ulcers.
 Externally applied astringents, cause mild coagulation of
skin proteins, dry, harden, and protect the skin
 Acne sufferers are often advised to use astringents if
they have oily skin
Uses of astringents
• Stop bleeding
• Clean the face and prevent Acne Breakouts
• Haemorrhoids
• Relieve the discomfort and itching caused by
• insect bites,
• minor abrasions and
• Athlete’s foot
Hemostatic Agents-preparations
THANK YOU ALL