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Local and systemic hemostatics in trauma: a review
Gustavo Recinos1, Kenji Inaba, Joseph Dubose
1Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA.
Summary
Controlling hemorrhage in trauma patients is critical but challenging. This review covers advanced local and systemic hemostatic agents to aid surgical control in critically ill patients.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Surgical Hemostasis
Background:
- Hemorrhage is the primary cause of death in trauma patients.
- Effective hemorrhage control is vital but challenging in critically ill trauma cases.
- Advanced hemostatic agents offer adjuncts to traditional surgical methods.
Purpose of the Study:
- To review available local and systemic hemostatic products for trauma patients.
- To discuss the characteristics, indications, and limitations of these agents.
- To provide a rationale for their use in managing surgical bleeding.
Main Methods:
- Review of commercially available local hemostatic agents (oxidized cellulose, fibrin glue, synthetic adhesives).
- Examination of newer generation local hemostatics (Zeolite, Chitosan) under investigation.
- Analysis of systemic hemostatic adjuncts, including recombinant factor VIIa.
Main Results:
- First-line local agents include oxidized cellulose, fibrin glue, and synthetic adhesives.
- Newer agents like Zeolite and Chitosan are under efficacy and safety investigation.
- Recombinant factor VIIa shows promise for intractable bleeding, but its trauma indications and safety are under ongoing trials.
Conclusions:
- Various local hemostatic agents are available for trauma hemorrhage control.
- Emerging agents and systemic therapies require further investigation for definitive use.
- Understanding agent characteristics is key to optimizing their application in trauma care.
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