INTRODUCTION

Topical hemostatic agents are used when surgical hemostasis is inadequate or impractical. The majority of routine, elective operations are performed in patients with normal hemostasis and with minimal blood loss

The mechanism of action, indications, and the clinical application of the most common topical hemostatic agents used in surgery are reviewed here. Devices used to achieve surgical hemostasis through vascular control during dissection are discussed elsewhere. (See "Overview of electrosurgery" and "Devices for dissection and hemostasis in laparoscopic surgery".)

INDICATIONS FOR USE

Intraoperative bleeding is controlled using standard surgical techniques and electrocautery with the adjunctive use of topical hemostatic agents.

Electrocautery may not be useful for controlling bleeding in some surgical fields such as around nerves, medullary bone surfaces, needle-hole bleeding from vascular grafts, and raw areas on cut surfaces. Patients who are anticoagulated and those with bleeding diatheses (eg, factor deficiencies, disseminated intravascular coagulation), or have platelet dysfunction (eg, aspirin therapy) can continue to ooze from surgical surfaces in spite of adequate surgical hemostasis.

Under ideal circumstances, patients with hemostatic abnormalities have their underlying defects corrected prior to proceeding with surgery; however, this is not always possible. Anticoagulated patients, patients receiving antiplatelet therapy, and those with congenital or acquired bleeding diatheses may require emergency surgical procedures to manage trauma or unrelated conditions or to manage hemorrhage that is a result of their disorder. Under these circumstances, correction of the hemostatic defect is undertaken en route to or simultaneously with the procedure. Hemostatic abnormalities can also develop during the course of surgery (eg, hypothermia, disseminated intravascular coagulation).