A comprehensive review of topical hemostatic agents: efficacy and recommendations for use
Ann Surg
vol. 251, 217 - 228, 2010
Abstract
Since ancient times we have attempted to facilitate hemostasis by application of topical agents. In the last decade, the number of different effective hemostatic agents has increased drastically. In order for the modern surgeon to successfully choose the right agent at the right time, it is essential to understand the mechanism of action, efficacy and possible adverse events as they relate to each agent. In this article we provide a comprehensive review of the most commonly used hemostatic agents, subcategorized as physical agents, absorbable agents, biologic agents, and synthetic agents. We also evaluate novel hemostatic dressings and their application in the current era. Furthermore, wholesale acquisition prices for hospitals in the United States are provided to aid in cost analysis. We conclude with an expert opinion on which agent to use under different scenarios.
Commentary
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B: Evidence from a well-diagnosed, non-randomized clinical trial. A non-quantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality randomized clinical trials, clinical cohort studies and case-controlled studies with nonbiased selection of study participants and consistent findings. Other evidence, such as high-quality, historical non-controlled studies, or well-designed epidemiological studies with compelling findings, is also included.
Opening with fascinating historical references, the authors of this review article present the currently available topical hemostatic agents, and make recommendations about the indications for each. In each instance, the goals are to stop bleeding, minimize adverse reactions, eliminate or even treat infections, and promote healing. Table 1 in the original article provides descriptive overviews of the products, and Table 2 in the original article presents costs and physical characteristics of them. Many of the included hemostatic agents are used only in the operative room, which limits the article's applicability to emergency medicine. For the emergency physician, the most salient section to read relates to the hemostatic dressings. These products can be a critical part of an emergency physician's armamentarium when confronted with life-threatening bleeding. The article does provide breadth, but not the requisite depth of information. Specifically, they omit 2 of the most important limitations of the dry fibrin sealed dressing. First, the formed plastic frame that gives structure to the dressing forbids molding or forming into a deep wound. Second, the appearance of the bandage makes distinguishing which side is the “business” one almost impossible.
