Local and systemic hemostatics in trauma: a review.
Hemorrhage is the leading cause of trauma-related deaths. The early identification and surgical control of this hemorrhage is the crucial first step in the management of the injured patient; however, this objective remains challenging in the most critically ill trauma patients. As an adjunct to traditional methods of surgical hemorrhage control, several advanced hemostatic agents are currently available. Oxidized cellulose, fibrin glue and synthetic adhesives constitute the first-line of local hemostatic agents. Materials such as Zeolite and Chitosan comprise the newest generation of local hemostatics and the efficacy and safety of these agents are currently under investigation. Recombinant factor VIIa has emerged recently as a promising systemic hemostatic adjunct for the treatment of intractable surgical bleeding; however, until completion of the ongoing multinational randomized control trial, the indications for its use in trauma patients and its safety profile are unclear. This article reviews the role of commercially available local and systemic hemostatic products in the trauma patient population; it also addresses the unique set of characteristics, indications, limitations and rationale for their use.
Recinos
Gustavo
G
Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA.
Inaba
Kenji
K
Dubose
Joseph
J
Demetriades
Demetrios
D
Rhee
Peter
P
D001777:Blood Coagulation / Q000187:drug effects; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D017641:Zeolites / Q000627:therapeutic use
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D017641:Zeolites