Chitosan-based antibacterial hemostatic sponge for uncontrollable tooth extraction bleeding in anticoagulated patients

Anticoagulant therapy substantially increases the risk of post-extraction hemorrhage by impairing hemostasis. In this study, we designed a quaternized carboxymethyl chitosan/polydopamine composite hemostatic sponge (QCD) that combines mechanical robustness and biocompatibility. Compared with the Gel group, QCD exhibits markedly enhanced in vitro hemostatic and antibacterial performance; the quaternary ammonium modification confers potent antibacterial activity tailored to the complex oral environment and mitigates infection risk. In vivo, tooth extraction test in anticoagulated rats showed that QCD (blood loss 0.011 ± 0.001 g, hemostasis time 59.667 ± 4.163 s) significantly outperformed a commercial gelatin sponge (0.019 ± 0.001 g, 87.000 ± 4.082 s) in hemostasis. This superiority was attributable to its rapid blood absorption and enhanced adhesion of blood cells and platelets, which together promoted clot formation. These results suggest that QCD may serve as a practical and promising approach for managing post-extraction hemorrhage in anticoagulated patients.