We summarized other pertinent literature and categorized the topical hemostatic agents into four major categories: topical active agents, topical mechanical agents, topical synthetic/hemisynthetic agents, and external hemostatic dressings. Since we are aiming for perioperative and traumatic hemostasis, we did not include dental literature or veterinary literature. We searched the PubMed Central with “topical hemostatic agent” in April 2020, when we started working on this manuscript, and found 1859 items.
The aim of this manuscript, therefore, is to help all healthcare providers understand and appropriately use these new hemostatic agents in accordance with clinical settings, patient coagulation status, and surgical scenarios. Topical hemostats are often used as adjunctive measures to improve hemostasis during or after surgery. External hemostatic dressings can be used to stop bleeding in emergency situations, such as in combat injury or junctional (groin or axillary) hemorrhage. Some new intravenously-administered pharmacological agents and topically-applied hemostatic agents have been developed in the last decades aiming to facilitate hemostasis by providing either intravascular coagulation cascade component(s) or extravascular substrate(s). In emergency rooms, trauma sites or battlefields, tourniquet and anti-shock trousers are commonly used options. Intraoperatively, surgeons usually employ direct mechanical pressure or compression, thermoelectric cautery, and surgical ligation to stop bleeding. When there is a bleeding, surgeons and other health care providers can utilize many techniques to stop bleeding. In this review, we summarize what is new in topical hemostatic agents.
There are pharmacological and non-pharmacological strategies to facilitate hemostasis. Some of these patients will require allogeneic blood transfusion, which has its own intrinsic risks, such as infectious disease transmission, allergic reactions, hemolytic reaction, and lung injury. The extent of cellular injury and organ dysfunction secondary to hemorrhage is a complex process dependent upon the duration and severity of bleeding and hypoperfusion. Hemorrhage ensues if the vascular wall integrity gets disrupted. Severe hemorrhage can potentially induce significant morbidity and mortality. Various factors, such as surgery and trauma, can cause hemorrhage in human beings.
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