Bloody marvellous

With the aging population more and more of our patients are on various forms of anti-coagulants - all the way from a simple daily aspirin right up to warfrin.This causes a problem.A lot of hemostatic agents contain aluminum chloride and, in my experience, they are very ineffective in patients on anticoagulants.I had a case recently where I thought the nurse must have put out plain water because the hemostatic was so slow to work.Much better are hemostatics that are based on ferric sulphate. They work far faster and are still effective even in patients on anticoagulants.The difference can be dramatic.With an aluminum chloride based agent it can take 10 minutes or more to get hemostasis. With a ferric sulphate based agent you can get the same result in 20 seconds.One caveat. You do have to wash off a dark brown coagulum with ferric sulphate agents.