MSD Manual

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Topical and Systemic Hemostatic Agents

Topical and Systemic Hemostatic Agents

Product Type


Mechanisms of Action

Specific Indications and Doses




Ferric sulfate

Silver nitrate

Tannic acid

Local precipitation of proteins

Bleeding nail beds

Can damage surrounding tissues

Exothermic reaction resulting in discomfort




Local vasoconstriction


Dental bleeding

Applied with cotton-tipped applicator or soaked tampon inserted into nasal passages

Can be difficult to apply

Efficacious only for small-vessel bleeding

Mechanical hemostatic agents

Porcine gelatin

Oxidized regenerated cellulose

Microfibrillar collagen

Mechanical barrier to bleeding; matrix for clot formation

Some products also bactericidal

Hepatobiliary surgery

Laparoscopic splenic biopsy

Mechanical hemostatic agents for bone

Bone wax

Alkylene oxide copolymer

As for other mechanical hemostatic agents; designed specifically for bleeding bone surfaces

Spinal surgery




Active hemostatic agents, including sealants

Fibrin sealants

Topical thrombin

Thrombin + gelatin

Active stimulation of hemostasis; active coagulation factors

Include clotting factors with or without structural matrix

Broad applications


Antidiuretic hormone analog

Desmopressin (1-deamino-8--arginine vasopressin)

Stimulates release of von Willebrand factor from vascular endothelial cells and platelets

Type I von Willebrand disease


1 mcg/kg, IV or SC, 30 min before surgery, then q 90 min during surgery

Hypersensitivity reactions reported

Affects free water balance

Vitamin K

Vitamin K1(phytonadione)

Necessary for hepatic synthesis of procoagulant factors II, VII, IX, and X

Anticoagulant rodenticide toxicosis

Moldy sweet clover (dicumarol) toxicosis (cattle)

Sulfaquinoxaline toxicosis (pigs, poultry)

Synthetic dysfunction in hepatic failure

Dietary deficiency

For dicumarol or first-generation anticoagulant rodenticide toxicosis, liver failure, or dietary deficiency: 0.25–5 mg/kg, SC or PO, q 24 h for 2 wk

For second-generation anticoagulant rodenticide toxicosis: 2.5–5 mg/kg, SC or PO, q 24 h for 4 wk

Anaphylactic reactions reported with some formulations when administered IV

With IM injection, risk of hemorrhage associated with underlying disease

Possible requirement of accompanying plasma-product treatment because new clotting factor synthesis has been reported to take 6–12 h

Plasma products

Fresh frozen plasma (FFP)

Refrigerated plasma (RP)

Frozen plasma (FP)


Cryo-poor plasma

Platelet-rich plasma (PRP)

Platelet concentrate (PC)

Replacement of lost or deficient coagulation factors or (in the case of PRP, PC) platelets

Clinical bleeding associated with congenital or acquired coagulopathy

Platelet products indicated for active bleeding associated with thrombocytopenia or thrombocytopathia

For FFP, RP, or FP: 6–20 mL/kg, IV, to effect

For cryoprecipitate, cryo-poor plasma, PRP, or PC: 1 U/10 kg, IV slowly over 4 h, to effect

Risk of transfusion reactions, including allergic reaction, febrile nonhemolytic reactions, transfusion-related acute lung injury Reduce rate if patient predisposed to cardiac overload


Epsilon-aminocaproic acid

Lysine analogue, blocking the lysine-binding site of plasminogen, thereby preventing plasmin activation

50 mg/kg, IV or PO, q 6–8 h, to effect

For Greyhounds: loading dose 15–40 mg/kg, IV; then 500–1,000 mg, PO, q 8 h for 5 d

Mostly GI effects (nausea, vomiting, abdominal pain, diarrhea)

Tranexamic acid

As for epsilon-aminocaproic acid

10–15 mg/kg diluted, IV slowly, q 8 h; or 10 mg/kg bolus, then 10 mg/kg/h CRI for 3 h

Topical use also reported

GI effects (nausea, vomiting), thrombotic events, and neurotoxicosis (humans)