Hemostatics

Hemostatics, or hemostatic agents, are substances that promote hemostasis, the cessation of bleeding. They are used in surgery, dentistry, trauma care, and wound management to reduce blood loss and aid wound closure. They are commonly categorized as local (topical) agents applied to the bleeding site and systemic agents that affect coagulation pathways.

Local hemostatics include mechanical barriers such as absorbable gelatin sponge (Gelfoam) and oxidized regenerated cellulose (Surgicel), collagen-based products, and tissue adhesives. These materials provide a scaffold for clotting, physically seal vessels, or combine with coagulants such as thrombin or fibrin sealants to accelerate hemostasis.

Systemic hemostatics include antifibrinolytics like tranexamic acid and aminocaproic acid, which stabilize clots by inhibiting plasmin. In selected patients, desmopressin increases von Willebrand factor and factor VIII. For major bleeding, concentrates of coagulation factors or prothrombin complex concentrates may be used under specialist supervision. Risks include thrombosis and transfusion reactions.

Usage depends on the cause of bleeding, patient factors, and regulatory approval. Hemostatic agents complement mechanical measures and blood products. Ongoing research aims to improve safety and efficacy, with developments in safer fibrin sealants and novel synthetic materials.