Obtaining rapid and effective hemostasis: Part I. Update and review of topical hemostatic agents

Effective and rapid hemostasis is critical to optimize surgical outcomes. An advantageous adjunct in accelerating the clotting process during dermatologic surgery is the use of topical hemostatic agents, which allow dermatologic surgeons to quickly clear the surgical field while avoiding the adverse effects of systemic medications. The growing rate of patients with pacemakers and defibrillators limits the possibility of electrosurgery. It is not unusual for patients to be taking ≥1 anticoagulant medication(s). For these reasons, the use of topical hemostatic agents is likely to gain more recognition in the literature. The term topical hemostatic agents encompasses an array of pharmacotherapies, sealants, adhesives, absorbable agents, biologics, and combination products. The optimal use of topical hemostatic agents demands that dermatologic surgeons be familiar with each of these options, because the type of product used must be selected based on surgical location, wound size, and the extent of bleeding. With few randomized controlled trials in existence reviewing the efficacy of these medications, the subject of topical styptic agents has largely gone unstudied. Part I of this continuing medical education article reviews the available topical hemostatic agents and the ideal clinical settings for their use.