Education Blog for Healthcare Professionals

Minor Cuts and Nosebleeds on Anticoagulants

When a patient on warfarin bleeds more than usual it is, of course, important to make sure that the INR is not supra-therapeutic.  And, if the INR is too high, warfarin therapy needs to be adjusted and other treatment (vitamin K, etc) may have to be employed depending on the degree of INR elevation and bleeding.  However, in case of minor bleeds on anticoagulants, such as skin cuts or nosebleeds, several over-the-counter products are available and  may be helpful for the patient.

  1. WoundSeal®
    This product contains a hydrophilic polymer and a potassium salt, and works by forming an artificial scab over minor cuts. It is available as a powder for skin cuts and  as a nasal applicator for nosebleeds.  Further information can be found on the company’s website.
  2. Seal-On®
    This product contains cellulose and works by forming a gel-like layer over the cut.  It is available as a spray powder, bandage, adhesive or sterile pad, blotter, or nasal sponge.  Further information can be found on the company’s website.
  3. QuikClot®
    These products to stop bleeding from cuts or nosebleeds are made with a natural mineral called zeolite. Zeolite is an activator of the coagulation coascade. Further information can be found on the company’s website or here.
  4. BloodSTOP®
    This is a product made of plant cellulose. When BloodSTOP comes in contact with blood, it forms a clear gel that seals the wound with a protective transparent layer. More information is on the company’s website.
  5. NasalCEASE®
    This is made of a bio-polymer called calcium alginate. It provides a surface on which blood can clot. It can be used in the nose for nosebleeds, but als on skin cuts. More information is on the company’s website.
  6. BleedArrest®
    The active ingredient in BleedArrest is a natural plant-based polymer, called amylopectin. It provides a surface on which blood can clot.  More information is on the company’s website.
  7. Celox™
    Celox granules are large surface area flakes. it is said that when they come in contact with blood, they swell, gel, and stick together to make a gel like clot, which plugs the bleeding site.  Celox does not activate the normal clotting cascade.  
    More information can be found on the company’s website.
  8. There used to be a product from Johnson & Johnson called Band-Aid Liquid Bandage which was, however, discontinued.

I am not aware of clinical, patient-based, peer-reviewed scientific publications on these products, i.e. studies on how good and effective they are.  A number of them are being marketed in the most glowing terms – “life saving battlefield technology”, etc – with little or no published human data to back up these enthusiastic statements.  Products may be available for purchase over-the-counter at pharmacies near the first aid products or through the internet.  Other products may be available that I am not aware of. I do not have enough experience with these products to know whether (a) they are effective in patients on anticoagulants, and (b) one may be more effective than the other.

Patient Question:

Q:     “I am on warfarin and will be traveling to Africa for a few weeks. Is there anything I can take with me in case I have a cut or a nosebleed that doesn’t want to stop bleeding?”

A:     It may be reasonable to take a product along that one can apply for nosebleeds or cuts.

Disclosure: I have no financial disclosures relevant to this post.

Last updated: Sept 7th, 2011

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