Topical and Systemic Hemostatic Agents
Topical and Systemic Hemostatic Agents
Product Type | Examples | Mechanisms of Action | Specific Indications and Doses | Disadvantages |
|---|---|---|---|---|
Topical | ||||
Astringents | Ferric sulfate Silver nitrate Tannic acid | Local precipitation of proteins | Bleeding nail beds | Can damage surrounding tissues Exothermic reaction resulting in discomfort |
Catecholamines | Epinephrine Norepinephrine | Local vasoconstriction | Epistaxis 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 Maxillectomy Mandibulectomy Sternotomy | — |
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 | — |
Systemic | ||||
Antidiuretic hormone analog | Desmopressin (1-deamino-8-ᴅ-arginine vasopressin) | Stimulates release of von Willebrand factor from vascular endothelial cells and platelets | Type I von Willebrand disease Hemophilia 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) Cryoprecipitate 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 |
Antifibrinolytics | ||||
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) | |