Hematology: Topical Hemostatic Agents

Physical Agents

Microporous Polysaccharide Spheres (MPS)

  • Mechanism: Absorbs Water to Concentrate Platelets/Clotting Factors
    • Derived from Potato Starch
  • Form: Powder
  • Variations:
    • Arista
  • Rapid Absorption: 24-48 Hours
  • No Risk for Infection or Foreign Body Reaction

Oxidized Regenerated Cellulose (ORC)

  • Mechanism: Oxidized RBC Lysis Creates an Artificial Clot
  • General Form: Mesh
  • Variations:
    • Surgicel Original
    • Surgicel Fibrillar – Fibrous Structure ‘Melts’ into Tissue
    • Surgicel Nu-Knit – Stronger Variation with High Tensile Strength
    • Surgicel SNoW – Single-Layer
    • Surgicel Powder
  • Absorption: 1-2 Weeks
  • Unabsorbed Mesh is a Risk for Infection/Abscess

Absorbable Gelatin Matrix

  • Mechanism: Hydrocolloid Absorbs Blood to Increase Weight/Size & Create an Artificial Clot
    • Often Moistened with Thrombin to Improve Effect
  • Form: Sponge
  • Variations:
    • Gelfoam
    • Surgifoam
  • Absorption: 4-6 Weeks
  • Increased Risk for Infection & Fibrosis

Microfibrillar Collagen (MC)

  • Mechanism: Absorbable Acid Salt Creates a Large Scaffold for Platelet Adhesion & Thrombus Generation
    • Poor Effects in Thrombocytopenia
  • Form: Sheets
  • Variations:
    • Actifoam
    • Avitene (Ultrafoam)
    • Helistat
  • Absorption: 12 Weeks

Kaolin-Impregnated Sponge

  • Mechanism: Kaolin Activates Factor XII
  • Form: Gauze
  • Variations:
    • Quickclot
  • Does Not Absorb

Biologically Active Agents

Topical Thrombin

  • Mechanism: Application of Thrombin Uses Fibrinogen from the Blood to Form Clot
  • Form: Liquid
    • Reconstituted from a Lyophilized Powder
  • Combinations:
    • Often Used to Soak Absorbable Gelatin Matrix
    • Thrombin-Gelatin: Floseal & Surgiflo
    • Thrombin-Collagen: Costasis

Fibrin Sealant

  • Mechanism: Two-Component System Adds Both Fibrinogen and Thrombin
    • Mixed Together Before Use
  • Form: Liquid

Topical Tranexamic Acid (TXA)

Other Agents

Albumin-Based Tissue Adhesive

  • Mechanism: Causes Peptide Cross-Linking to Form a Scaffold Similar to Collagen
    • Albumin Mixed with an Organic Component Before Using
  • Form: Liquid
  • Variations:
    • Bioglue – Bovine Albumin & Glutaraldehyde
    • FocalSeal-L – Human Albumin & Polyethylene Glycol