title: Use of local pro-coagulant haemostatic agents for intra-cavity control of haemorrhage after trauma.
abstract: BACKGROUND
  Uncontrolled haemorrhage as a result of trauma remains a significant surgical challenge, accounting for approximately 25-40% of trauma-related mortality. A wide range of local internal haemostatic agents have been developed to help achieve intra-cavity control of bleeding, with choice of agent influenced by the circumstances and nature of the haemorrhage. Trauma patients are frequently coagulopathic, so products that incorporate pro-coagulant technology and thereby act independently of the clotting cascade may be more effective in these settings. A range of products that utilise thrombin and fibrinogen to promote local haemostasis at intra-cavity bleeding points are available or in development, including fibrin glues (e.g. Tisseel®/Tissucol® and Evicel®/Crosseal®/Quixil®), fibrin sealant patches (e.g. TachoSil®) and products based on a gelatin-thrombin haemostatic matrix (e.g. FloSeal®).
  
  
  METHODS
  This systematic review was performed to assess all peer-reviewed evidence of product efficacy.
  
  
  RESULTS
  Fibrin sealant patches have shown haemostatic efficacy in a variety of surgical procedures and appear to offer practical advantages over liquid fibrin glues. Existing evidence suggests that patch products enable delivery of pro-coagulants to defined areas with less chance of dilution and/or displacement by blood flow, but they require a pressure buttress for a suitable amount of time to achieve good results after trauma.
  
  
  CONCLUSIONS
  Our experience, supported by other reports in the literature, suggests the use of such fibrin patches may provide an effective option in helping to control haemorrhage after trauma. However, there is a general paucity of clinical data for intra-cavity haemostatic agent use, with the majority of data being based on animal models and case reports. Further clinical evidence, ideally including comparative studies between different agents, would be beneficial in helping guide surgeon choice to the most appropriate products to use in trauma settings.
authors.affiliation: Hepatobiliary Surgery and Major Trauma, Nottingham University Hospitals NHS Trust and East Midlands Major Trauma Centre, Nottingham, UK. adam.brooks@nuh.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Navarro
authors.affiliation: Hepatobiliary Surgery and Major Trauma, Nottingham University Hospitals NHS Trust and East Midlands Major Trauma Centre, Nottingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Brooks
mesh_terms: D000818:Animals; D001458:Bandages; D004195:Disease Models, Animal; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005780:Gelatin / Q000008:administration & dosage; D006470:Hemorrhage / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D005780:Gelatin
keywords: Coagulopathy; Fibrin sealants; Haemorrhage; Haemostasis; Haemostatic agents; Trauma