Med Report: Know your hemostatic agents
Mary Ann Alexander-Magalee MSN, RN, CNOR, BC

OR Nurse 2014
January 2014 
Volume 8  Number 1
Pages 17 - 21
  PDF Version Available!

The past decade has yielded many advances in biotechnology, resulting in an explosive growth in hemostatic agents available to today's surgeons.1 This article reviews the most commonly used hemostatic agents for topical hemostasis and sealants and the advantages and disadvantages of physical, absorbable, biologic, and synthetic agents.The formation of a blood clot typically occurs within a prescribed sequence of events: When a blood vessel ruptures, a series of complex chemical events occur via extrinsic and intrinsic pathways, ultimately resulting in the formation of prothrombin activator (see The intrinsic and extrinsic coagulation pathways). The prothrombin activator then catalyzes the conversion of prothrombin into thrombin. Finally, thrombin is a catalyst in the conversion of fibrinogen into fibrin, which enmeshes the initial platelet plug and forms a true clot.1,2Optimal hemostasis generally occurs when a surgical technique controls all surgical sources of bleeding and the patient's own coagulation system effectively seals microvascular bleeding. In this favorable situation, no hemostatic management is necessary; however, ideal operative situations don't always transpire. Clinical options include adequate surgical technique that controls all discrete large vessel bleeding, attention to the physical state of the patient (such as temperature, hemodynamic status, and pH), and use of topical hemostatic agents.1,2The question of which agent to use depends on the type of bleeding, the agent's specific mechanism of action, its interaction with the environment, and the patient's individual coagulation abnormalities. The cost and availability of an agent are also important factors when determining which agent to use.1 The ideal hemostatic agent would be easy to use, highly efficacious, nonantigenic, fully absorbable, and cost effective.Bone wax is a nonabsorbable mixture of beeswax, paraffin, and isopropyl palmitate (a wax-softening agent) that's inexpensive and easy to

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