[Local and systemic hemostasis in surgery].
Surgery inevitably leads to bleeding, and hemostasis aims at reducing the amount of blood loss and the need for transfusion as well as preventing rebleeding, hematoma formation, and the need for repeat surgery. Various locally applicable agents are in use including bone wax, gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues. Some evidence from randomized controlled trials (RCT) exists regarding the use of fibrin sealants on their own or combined with collagen fleece. Systemic hemostasis may be achieved with lysine analogs such as epsilon-aminocaproic acid or tranexamic acid and aprotinin, which are inhibitors of fibrinolysis. There is much albeit sometimes conflicting evidence from RCT regarding the use of these substances in surgery. The role of recombinant activated factor VII in achieving systemic hemostasis is being investigated.
Bechstein
W O
WO
Klinik für Allgemein- und Gefässchirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, 60590 Frankfurt am Main. wolf.bechstein@kgu.de
Strey
C
C
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015942:Factor VIIa / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000627:therapeutic use; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation; D015337:Multicenter Studies as Topic; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives; D014148:Tranexamic Acid; D007611:Aprotinin; D015942:Factor VIIa