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Thrombostatic Agents and Tissue Adhesives in the Emergency Department



Complaints of bleeding are frequent presentations to the emergency department, and although most bleeding can be controlled with direct pressure, increased use of antiplatelet agents and anticoagulants complicates what might be otherwise simple bleeding. Industry has met the demand for hemostatic adjuncts, and a number of products are available for the emergency physician to assist in hemostatic control and wound closure. This chapter will cover the various available technologies, covering their preferred use and discussing particular bleeding scenarios and which technology may be best for each scenario.To get more news aboutаптечка FAK, you can visit rusuntacmed.com.ru official website.

Control of bleeding wounds has always been a priority in managing injured patients, and providers have used numerous adjuncts to staunch bleeding for decades, with variable success. The earliest use of topical hemostatic agents dates from the end of the nineteenth century when thrombin was used by boxers and barbers to control bleeding from lacerations [1]. Almost a century before the clotting cascade was completely elucidated, in 1909 Bergel had described using topical fibrin to stop surgical bleeding [2, 3, 4]. Subsequently, surgeons utilized fibrinogen in plasma as well as bovine thrombin to assist in a variety of surgical scenarios, including nerve repair and skin grafting [5, 6]. Commercial products first became available in Europe in 1972, but the Food and Drug Administration did not approve fibrin sealants in the United States until 1998 [3]. Over the course of time, numerous other types of hemostatic agents have been developed, each unique in their load bearing capacity, biomechanical properties, handling, derivation, and application [7].
Cutaneous and mucous membrane bleeding are common presentations to emergency departments. Data from the National Hospital Ambulatory Medical Care Survey in 2002 estimated that there were 7.27 million emergency department visits for lacerations, representing approximately 6.6% of all emergency department visits [8], and data from HCUP National Emergency Department Survey in 2013 estimated about 7 million emergency department visits or 5.2% of all visits for lacerations [9]. There are no data to quantify how many of these visits are associated with uncontrolled or major bleeding. The mainstays of treating bleeding remain the simple application of direct pressure with a pressure bandage and application of tourniquet if hemostasis is unable to be obtained. However, there are times that application of hemostatic agents can assist in bleeding control. In the modern era, with widespread use of anticoagulant and antiplatelet agents, as well as physiologically induced coagulopathies from liver disease and uremia, development of topical hemostatic agents to assist in terminating complex bleeding scenarios has become important.

We will briefly review classes of tissue adhesives, topical hemostatic agents, and the best practice data regarding each in the setting of the emergency department. We will provide common clinical bleeding scenarios and the application of these materials in those situations.
work by providing a physical substrate which promotes hemostasis and the biologically active agents that enhance coagulation at the site of action(Table 1). In the emergency department, topical hemostatic agents are primarily used as adjuvant therapy to direct pressure to stop persistent bleeding from lacerations and abrasions that are not amenable to suture control, such as distal fingertip avulsions, flap lacerations with avulsion of the flap, and skin tears in the elderly. As well, topical hemostatic agents can be used to assist with persistent bleeding from nasal mucosa, gingival tissue after tooth extraction, and from vascular bleeding sites such as persistently bleeding dialysis access sites or bleeding lower extremity varices.