Role of Hemo - coagulase as a Local Haemostatic Agent after extraction of tooth
ORIGINAL ARTICLE
Role of Hemo - Coagulase as a Local Haemostatic Agent after
extraction of tooth
D. A. Solanki1, Nehal D. Modha2
1
Assistant Professor, Oral & Maxillofacial Surgeon, 2Dept. of Dentistry, P.D.U. Govt. Medical College & Hospital, Rajkot
ABSTRACT
BACKGROUND: Haemocoagulase is the fractional isolate of poisons “Bothrops Jararca”. It is enzyme complex. It
has coagulative and anti-hemorrhagic properties. This prospective study compared two extraction sites in each
subject. One site received topical hemocoagulase while other site did not receive it. Both the sites were chosen in the
same patient and extraction was done at separate intervals. Hemostasis immediately following tooth removal was
achieved by pressure pack technique on control side and on test side haemocoagulase was applied and time
measurement was done. It has been concluded from this study that haemocoagulase not only helps in achieving
hemostastis but also helps in faster healing of the wound by rapid formation of healthy tissue and reducing the
amount of infection which may alter the normal healing process.
KEY WORDS: Haemocoagulase, hemostasis, tooth extraction
*Corresponding Author:
Dr. D. A. Solanki, M.D.S.
Oral & Maxillofacial Surgeon,
Assistant Professor, Dept. Of Dentistry,
P.D.U. Govt. Medical College & Hospital,
Rajkot.
Email: [email protected]
No: +91 94260 45756
pharmaceuticals) – a topical preparation
that is prepared from snake venom
contains extracted hemocagulase. It is used
for its procoagulant properties as well as
healing properties. It has been introduced
to arrest bleeding at the site of injury.
Botroclot, a non toxic systemic
hemocoagulant fraction of venom is
obtained from the Brazilian snake
Bothrops-jararaca or atrox. Preparations
are available all over the world by
different names e.g.: Boroxobin - a WHO
approved product, Botropase - a systemic
procoagulant. The preparation of Botrolcot
topical solution in each ml contains: (a)
Bothrops atrox or Bothrops jararaca 0.2
Cu/ml. (b) Chlorhexidine 0.1 % v/v (as a
preservative) and (c) Water for injection IP
q.s.
Haemocoagulase
has
multifaceted
procoagulant actions. It accelerates the
formation of fibrin monomers and hastens
fibrin clot formation. It activates factor Xa
helps in the formation of thrombin at the
site of hemorrhage. It is also found to
stabilize the fibrin by an action of the
Factor XIIIa. A few reports have suggested
that this parenteral preparation acts like a
prohealer,
enhances
epithelization,
increases wound tensile strength and
turnover of collagen in the healing wound.
It reduces bleeding time, promotes wound
healing by promoting the growth of
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INTRODUCTION
Bleeding during oral surgical procedures
can cause distress, agony and discomfort
to the patient. It also distracts the oral
surgeon from operating field leading to
frustration and time consumption.
Bleeding can be due to variety of local or
systemic factors, control of which may
require additional haemostatic agent as
well as considerable aromor of the
surgeon. Therefore, knowledge of
fundamental of normal and deranged
hemostatsis is a critical factor in successful
and eventful conduction of a surgical
procedure and obtaining of maximum
patient
compliance,
along
with
achievement of clear dry surgical field.
Drugs that arrest bleeding, promote
epithelization and provide relief from pain
have been widely used in oral surgical
procedures. It is a well known fact that
snake venom, one of the most concentrated
enzyme sources, is a valuable expedient of
the healing process. Botroclot (Jaggat
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7th day
10th day
5th day
3rd day
1st day
15
2nd day
No. of Patients
Role of Hemo - coagulase as a Local Haemostatic Agent after extraction of tooth
capillaries in wound space. It is highly
with
hemocoagulase
solution
and
resistant to plasmin wherein no withdrawal
measurement of time from application of
bleeding is found.
solution in to socket upto the complete
Considering all these therapeutic uses of
stoppage of bleeding by stopwatch was
Haemocoagulase, a present study was
done.
carried out and analysis of 100 cases was
After 24 to 48 hours later, extraction
done.
procedure was carried out at another site
which required extraction, as identified on
MATERIAL & METHOD
This study was conducted at period of 1
day one. Saline pressure pack was given to
Year from April 2014 to March 2015.
achieve hemostasis at this site. This site
Patients were included during the study
was chosen as the control site.
period if they satisfied the inclusion
Hemocoagulase was not applied to this
criteria. The study protocol was explained
site. Post-operative care and follow-up was
and informed consent was obtained from
done.
all patients who were involved in the
RESULTS AND OBSERVATIONS
study. Patients who could not adhere to the
Table 1, Graph 1: Patient distribution
study protocol of the follow-up were
according to the time required to stop
excluded from the study. Inclusion criteria
bleeding
Time (Mins)
Test Side
Control Side
were: patients aged between 18 and 65
0.0-1.0
years
undergoing
multiple
tooth
1.0-1.25
30
extractions (because of grossly decayed or
1.25-1.50
20
non-restorable
teeth,
or
severe
1.50-1.75
36
periodontitis). This ensured that same
1.75-2.00
patient could have both the hemocoagulase
2.00-2.25
4
2.25-2.50
10
and control site. All the sites were chosen
2.50-2.75
10
such that they were not located in close
2.75-3.00
24
proximity and extractions were done at
3.00-3.50
36
different time intervals. Extractions of
3.50-4.00
16
third molars were not included. This
4.00-4.50
14
ensured that hemocoagulase did not spread
4.50-5.00
to the control site. The site where
Patient distribution according to the time
hemocoagulase was applied was taken as
required to stop bleeding
100
“test” site where as other site was chosen
as the “control” site in the same patient.
80
Exclusion criteria included patients with
60
known
premorbid
conditions
like
40
thromboembolic disorders, hypertension,
20
hemophilia,
diabetes
mellitus,
0
anticoagulant therapy, pregnant patients,
hypersensitivity to hemocoagulase topical
Test Side
Control Side
solution and other constituents of the
Time (Mins)
formulation, HIV – positive patients and
patients with mental illness. Clinical
Table 2, Graph 2: Number of patients
information with respect to demopraphic
having pain after extraction
details, reason for extraction was noted.
Time (Days)
Test Side
Control Side
Once the patients were included in the
1st day
60
80
study, complete blood count, coagulation
2nd day
80
82
profile, bleeding time and clotting time
3rd day
36
60
were evaluated. Extraction was done under
5th day
10
34
local anesthesia (2% lignocaine with
7th day
10
10th day
1:1,00,000 adrenaline) using standard
surgical technique. At the first site after
extraction, extraction socket was filled
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16
7th day
6th day
5th day
4th day
3rd day
1st day
2nd day
No. of Patients
No. of Patients
Role of Hemo - coagulase as a Local Haemostatic Agent after extraction of tooth
glue are technically difficult to manipulate,
Number of patients having pain after
extraction
especially in wt regions such as bleeding
100
extraction sites, also they carry the risk of
viral disease transmission, and last but not
0
the least these agents are very expensive.
1st 2nd 3rd 5th 7th 10th
The special feature of hemocoagulase
day day day day day day
Test Side
centers on the fact that, its thrombin like
Control…
Time (Days)
action is present even in the absence of
clotting factors. It also enhances the
Table 3, Graph 3: Number of patients
conversion of prothrombin into thrombin.
having swelling after extraction
Time (Mins)
Test side
Control side
The actions of hemocoagulase continue
1st day
40
even in the presence of anti-thrombin and
2nd day
50
60
are not absorbed in fibrin clot; hence the
3rd day
30
36
action of hemocoagulase is prolonged.
4th day
10
14
Hemocoagulase helps to form a fibrin
5th day
4
th
bridge that promotes growth of capillary
6 day
st
and collagen fibers in wound space. This
7 day
hastens the wound healing by reducing the
Number of patients having swelling after
wound infection and thus benefiting the
extraction
patient.
100
In this study bleeding was stopped in range
0
of 1.00 to 2.50 minutes in all the patients,
with mean value of 1.42 minutes on the
test side. While on the control side
Test side
bleeding was stopped in range of 2.50 to
Time (Days)
4.50 minutes, with mean value of 2.18
Present study was conducted to study role
minute, hence faster haemostasis was
of hemocoagulase as a local hemostatic
achieved on hemocoagualse side (Table 1,
agent in tooth extraction. 100 patients were
Graph 1).
selected according to inclusion criteria and
Table 2, Graph 2 shows less pain was
evaluated primarily for bleeding from the
experienced
by
the
patients
on
extraction wound and additionally for
hemocoagulase side. It shows that there
pain, swelling and healing. (See Table: 1,
was 60% patients having pain on
2, 3 and Graph: 1, 2, 3).
hemocoagulase side as compared to
DISCUSSION
control side which was 80%. Again, only
Hemostasis in oral cavity is dependent
10% patients were having pain on fifth day
upon the dynamic balance between fibrin
on heomocagulase side as compared to
formation and resolution and is influenced
control side which was 34%.
by external environment, which contain
This reduction of pain at test side could be
both plasminogen and plasminogen
attributed to absence of persistent infection
activators. Therefore, knowledge of
in those sockets, otherwise, which could
normal and deranged hemostasis is a
have lead to subsequent delay in
critical factor to carry out a surgical
connective tissue formation within sockets.
procedure uneventfully and for obtaining
Hemocoagulase consists of an array of
good patient compliance.
procoagulant enzyme with thrombin like
Resorbable hemostatic agents such as gel
enzyme, endopeptidase and kininogen.
foam, absorbable collagen, microfibrillar
This augment enzymatic activity in healing
collagen etc. have risk of adherence and
phases, including clot formation and clot
infection specially if any portion remains
lyses. This helps for improving healing by
unabsorbed by tissue, also owing to
hemocoagulase.
hydrophilic properties of microfibrillar
In terms of swelling there was not much
collagen, it tends to adhere the gloves and
difference on both the sides on 2nd and 3rd
instruments, and it is expensive and messy.
post-operative day (Table 3, Graph 3).
Biological agents such as thrombin, fibrin
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Role of Hemo - coagulase as a Local Haemostatic Agent after extraction of tooth
V. Shenoy K. and associates showed in
8. Steiner GG, Francis W, Burrel R et al
their study that there was increased
(2008) The healing socket and socket
amount of osteoid formation in extraction
regeneration. Compend Contin Educ
sockets where hemocoagulase was applied.
Dent 29(2):114–124
They concluded that the application of
9. Amler MH, Johnson PL, Salman I
heomocagulase
may
improve
and
(1960) Histological and histochemical
accelerates the process of wound healing
investigation of human alveolar socket
in extraction sockets.
healing in undisturbed extraction
Analgesics and antibiotics were given to
wounds. J Am Dent Assoc 61(7):32–
those patients who returned with ain at the
44
control side for the symptomatic pain
10. Boyne PJ (1966) Osseous repair of the
relief, control of infection and swelling.
postextraction alveolus in man. Oral
Surg Oral Med Oral Pathol 21(6):805–
CONCLUSION
It has been concluded from present study
813 CrossRef
that application of hemocoagulase to
11. Devlin H, Sloan P (2002) Early bone
extraction socket will achieve faster
healing events in the human extraction
hemostasis and also reduce pain, swelling
socket. Int J Oral Maxillofac Surg
and helps in would healing by rapid
31(6):641–645 CrossRef
formation of healthy tissue and reducing
12. Castro HC, Zingali RB, Albuquerque
the amount of infection.
MG et al (2004) Snake venom
thrombinlike enzymes: from reptilase
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