Table 2 Hem Adjunctive measure to control residual mild or moderate bleeding (oozing and/or spurting) also in coagulation disorders

Liquid adhesives

Fibrinogen + thrombin:

Tisseel, Evicel, Beriplast, Vitagel, Cryoseal, Evarrest, Crosseal, Quixil

Human Thrombin:

Evithromb, Thrombin-JMI,

Rechothromb

+ Bovine gelatin

Floseal

+ Porcine gelatin

Surgiflo

Fibrinogen and thrombin mixed at the site of application to form clot.

Adjunctive measure to control residual mild or moderate bleeding (oozing and/or spurting).

Effective irrespective of patient’s coagulation status. Weak sealant effect

Do not use in individuals known to react to human blood products.

Increased risk of thrombosis with bovine thrombin.

Avoid intravascular administration because of thromboembolic risk.

Avoid tranexamic acid containing products if CSF leak because of neurotoxicity.

Gelatine granules can swell up to 20%

Adhesives with mechanical support

Fibrinogen + thrombin + equine collagen patch

TachoSil

The patch facilitates compression on bleeding site

Adjunctive measure to control residual severe bleeding because the patch prevents the streaming effect of blood.

Weak sealant effect

Mechanical hemostats

-Oxidized Cellulose

Surgicel (fibrillar, original)

Nu-Knit (fibrillar, original)

-Collagen (microfibrillar- MFC)

Avitene, Helistat/Helitene,

Instat/Ultrafoam

-Porcine gelatin

Gelfoam (flour, sponge, plus)

Surgifoam

-Polysaccharides spheres Arista AH

These agents can be used only in patients with normal coagulation system. They form a tri-dimensional matrix at the site of bleeding, which allows clotting to occur.

Provides physical matrix for clotting initiation; low pH contributes to platelet activation

Platelet adherence and activation

Concentrates platelets and clotting factors

Very good handling characteristics; does not stick to instruments; typically dissolves in 2–6 weeks; low pH has antimicrobial effect; effective on residual oozing

No significant swelling

Effective despite heparinization

Nonantigenic; neutral pH allows use with biological agents; effective on oozing and bleeding from bone

Rapidly absorbed; effective on residual mild bleeding if conventional method impractical

Not effective in coagulation disorders

It inhibits thrombin because of low pH; may induce inflammation for foreign body reaction; caution if used in narrowed spaces because it can swell.

Less effective if thrombocytopenia; may bind to neural structures; avoid if blood-saving device used as MFC can pass through the filters

Caution if used in confined spaces as it swells; remove the excess after obtained hemostasis; may embolize in intravascular compartments

Caution in diabetic patients;

Risk of embolism if accidentally injected or placed within a blood vessel.

Hemostatic dressings

Zeolite

QuickClot ACS+

Smectite

WoundStat

Kaolin

Quick Clot Combat Gauze (CG)

Chitin/chitosan

HemCon

Celox (CE)

(granules, gauze)

Molecular sieves absorb water at site of wound and increase concentration of clotting factors, platelets, RBCs.

Procoagulant agents which enhances coagulation by providing a high local concentration of coagulation factors.

Muco-adhesive agent with direct electrostatic interaction between negatively charged cell membranes of the erythrocytes and positively charged chitosan

Control of significant hemorrhage in anatomic areas where tourniquets cannot be applied and where sustained direct pressure alone is not feasible (neck, groin, axilla)

Bleeding wounds on the field

Bleeding wounds on the field. Can be poured into wound and conform to it. Easily portable

Removal much easier than other granules/powder agents

Exothermic reaction with risk of burn at the site of application for both the products

Not biodegradable, must be completely removed before definitive repair

Allergy to crustaceans. Eccessive stiffness