Hemostatics

Table 4 contains products available for Factor VII, Factor VIIFC (hemophilia A), Factor IX, and von Willebrand protein deficiency. Table 5 fists miscellaneous hemostatics and thein proposed mechanisms of action. 

Table 5. Miscellaneous Topical Hemostatics and Action Mechanisms...

The extent to which these new tissue adhesives and hemostats will influence surgical procedures can be seen in the following analogy. An effective carpenter cannot create a masterpiece without a saw to cut wood, nails to ensure local fixation of separate pieces of wood, and glue to cause broad surface apposition between wood surfaces. Similarly, the surgeon presently uses a scalpel to cut and divide tissues as well as a suture to create local fixation of tissues, but until... 

Presently approved new tissue adhesives and hemostatic agents... 

Components/ mechanism of action Human plasma, fibrinogen and thrombin, virally inactivated, hemostat, sealant. Autologous fibrinogen -t-platelet-rich plasma, hemostatic gel. Bovine collagen, bovine thrombin, plus autologous human plasma, hemostatic agent. Bovine collagen and bovine thrombin. Expands 20% which aids in hemostatic effect. 

In the following sections, a variety of different applications for tissue adhesives and hemostats will be reviewed and specific new agents presently available for clinical use will be discussed. 

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Tisxue adhesives ami hemostats new looisfor the siir eati... 

Prior, J., Wallace, D., Hamer, A. and Powers, N., A sprayable hemostat containing fibrillar collagen, bovine thrombin, and autologous plasma. Ann. Thome. Surg., 68, 479-485 (1999). 

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