Hemostatic Agents - How They Work & How to Use Them
In cases of massive traumatic bleeding, it is imperative to use quick and effective solutions that can raise the patient’s chances of survival. Hemostatic agents are specifically designed to stop the bleeding from injured blood vessels, thus playing a critical role in high-pressure scenarios.
Hemostatic agents are invaluable tools for traumatic injuries, surgical procedures, and military situations that involve heavy bleeding. Learn what hemostatic agents are, the different types of hemostatic agents, how they work, and when and how to use them, because this knowledge could one day help you save a life.
What Are Hemostatic Agents?
Hemostatic agents are substances that expedite blood clotting in bleeding emergencies. They can be administered systemically as well as topically. They are used to help prevent death from hemorrhaging and to minimize the risk associated with bleeding complications. The substances that make up a hemostatic agent vary depending on the specific product and its intended use.
Hemostatic agents are extremely helpful to have on hand and can be purchased at a variety of places including medical supply stores and some pharmacies. Purchasing from online trauma kit retailers is often the quickest and easiest way to be ready in case of an emergency.
Types of Hemostatic Agents
There are many types of substances used as hemostatic agents. They are all used to reduce blood loss and promote clot formation in trauma patients who have become injured in an accident or people who are undergoing surgical procedures. Each of the agents activates coagulation factors and has proven its efficacy and safety in promoting hemostasis.
Biologically Active Hemostatic Agents
A fibrin sealant, or fibrin glue, is used to promote blood clotting and tissue closing during surgery. Fibrin sealants are effective because they perform the same actions as the fibrin that is produced naturally by the body at the end of the clotting cascade.
Topical bovine thrombin, made from cows' blood, is not as popular today as in the past due to concerns of allergic reactions or the patient developing antibodies against bovine-derived proteins. Due to these concerns, topical recombinant human thrombin is more commonly used to promote hemostasis.
Natural Polymers
A natural polymer is a large molecule made up of repeating units. Natural polymers that promote clotting can be found in the natural world. They include:
- Chitosan
- Cellulose
- Hyaluronic Acid (HA)
- Alginate
- Collagen
Synthetic Polymers
Synthetic polymers are not found in the natural world. They are made from chemical reactions in laboratories or by industrial processes. Synthetic polymers that are used to promote clotting include the following:
- Peptides
- Polyethylene glycol (PEG)
- Polyurethane (PU)
- Polyvinyl alcohol (PVA)
- Polycaprolactone (PCL)
- Poly (ethylene oxide) (PEO)
Inorganic Hemostatic Agents
Inorganic hemostatic agents are usually made up of minerals, metals, or synthetic materials. Zeolites, mesoporous silica, graphene, and kaolin are some of the most well-known inorganic hemostats. Kaolin, for instance, is a mineral that when used on gauze and applied to a wound has been shown to effectively reduce active bleeding.
Metal-Containing Materials
Metal-containing minerals, like calcium, zinc, silver, and aluminum can be used as hemostatic agents as well. Aluminum sulfate, for instance, is used in the form of a powder or a gel to enhance the body's clotting abilities.
Carriers and Binders
Carriers and binders help carry hemostatic agents to the wound as well as help them bind to the area in need. There are three typical options for carriers and binders:
- Sponges
- Powders
- Gauze
Active agents can be placed on sponges and then set on the site of the bleeding. Powders are made by breaking down active agents into tiny pieces so that they can be placed directly on the bleeding wound. Gauze can be used as a type of web that holds the active agents in place as well as providing a space for clot formation.
The NuStat Hemostatic Dressing, for example, uses a unique technology consisting of silica and cellulose fibers. The cellulose quickly absorbs excess liquid and binds red cells. The silica encourages blood platelet activation and attachment. The gauze itself is used as the carrier and binder to help hold everything in place. These two hemostatic agents working together with the gauze create a beautiful partnership that promotes wound healing.
QuikClot® Combat gauze, in contrast, consists of nonwoven gauze impregnated with kaolin. Kaolin activates Factor XII in the blood. This accelerates the clotting process and helps in the creation of a robust blood clot. In a 2019 pig study, 100% of swine treated with QuikClot® Combat Gauze achieved hemostasis compared to 60% with Celox™ RAPID over the 1-hour observation period.
Healthcare professionals as well as first responders and military personnel must be prepared to stop severe bleeding quickly. First responders choose the best hemostatic gauze to use in an emergency according to the type of injury, the location of the injury, and the patient's condition.
Whether hemostatic agents are used in surgical, military, or general active bleeding situations, they give us more options for helping a bleeding patient survive.
How Do Hemostatic Agents Work?
In simple terms, a hemostatic agent works by quickening the natural blood coagulation response to injury. That means that hemostatic agents speed up the healing process. This is extremely helpful in emergency surgery and other situations with major blood loss.
The goal of a hemostatic agent is to encourage a lasting clot formation directly where injury has occurred. This is achieved via the following steps:
Step 1: Blood Contact
When the hemostatic agents are applied to the wound, contact is made between them and the blood flow.
Step 2: Clotting Cascade Activation
Upon contact, the active substances initiate the coagulation cascade. The coagulation cascade, also known as secondary hemostasis, occurs when a series of coagulation or clotting factors in the blood plasma cause soluble fibrinogen to change to insoluble fibrin. At this point, the wound stops bleeding.
When Are Hemostatic Agents Used?
As previously mentioned, hemostatic agents are used for a wide variety of emergencies. They are also used both in and outside of the hospital setting for serious blood loss scenarios. Surgical procedures including cardiac surgery, liver surgery, and other surgeries with increased risk for surgical bleeding use hemostatic agents to promote surgical hemostasis in the patient.
Cardiovascular & General Surgery
Coronary artery bypass grafting and other heart valve procedures often use hemostatic agents for controlling bleeding at the surgery site. Heart trauma patients routinely receive these agents.
General surgeries such as appendectomies or gastrointestinal surgeries also use hemostatic agents to maintain hemostasis.
Emergency Medicine and Trauma Care
Accidents resulting in traumatic injuries can require topical hemostatic agents to prevent hemorrhagic shock.
Trauma Surgery
Gunshot wounds, serious lacerations, or car accident injuries requiring emergency surgery all depend on the quick action of hemostatic agents. Trauma patients undergoing surgery can receive topical hemostatic agents at the bleeding site or an antihemorrhagic agent through an IV line.
Military and Combat Medicine
In both battlefield and other military settings, hemostatic dressings are carried for quick application. QuikClot® Combat gauze is a wise tool to carry whether you are in the military or simply want to be prepared.
Although these are not the only instances in which hemostatic agents are used to promote personal and surgical hemostasis, their use to stop traumatic bleeding (in any bleeding emergency) can be life-saving.
How to Use Hemostatic Gauze to Control Bleeding
Gauze containing topical hemostatic agents is a critical tool to quickly control blood loss in trauma patients. Knowing how to use hemostatic dressings to control active bleeding can make all the difference in saving someone's life.
To reap the benefits of hemostatic gauze, follow these three simple steps:
Step 1: Ensure Your Safety and Prepare to Act
- Call the emergency services or send a bystander to make the call. In the United States, call 9-1-1.
- Make sure that it is safe for you to approach the victim.
- Apply any personal protective gear that you may need, such as nitrile gloves, if available.
- If there is no spinal cord injury, have the injured person lie down on their back.
You will then need to find the bleeding site. Take note, if there is an object that is helping to keep the wound closed or clotting, such as a knife or clothing, do not remove it! However, it is helpful to cut clothing around the bleeding site before applying hemostatic gauze.
Please note that puncture wounds and other internal injuries can implicate internal bleeding. Internal bleeding may require the use of a tourniquet if the injury is located on an extremity (an arm or leg).
Step 2: Apply the Gauze
- Open the sterile gauze packet and remove the gauze.
- Apply firm pressure to the wound and attempt to pack the wound with the gauze so that the hemostatic agent can activate the coagulation cascade.
- If possible, elevate the injury above the person's head to reduce blood loss even further. If the blood soaks through the first layer of applied gauze, add another layer on top of it and press it into the wound to continue packing the wound. If you do not have additional hemostatic gauze, use standard wound packing gauze and continue to pack the wound behind the hemostatic gauze until fully packed.
- Continue to apply direct, firm pressure for a minute or so. If the patient is still bleeding through the hemostatic gauze and the wound is on an arm or leg, apply a tourniquet.
- Stay with the patient and continue to apply direct pressure until the emergency services arrive.
Important note: Gauze containing hemostatic agents shouldn't be used in head, eye, chest, or abdomen injuries. In these cases, use regular gauze and apply direct, sustained pressure to the wound. Vented chest seals such as the HyFin® Vent Compact Chest Seal can be used on penetrating chest wounds.
Save Lives With Hemostatic Agents
Hemorrhage is a leading cause of death in trauma patients. Keeping hemostatic agents on hand is imperative not only for first responders and military personnel but for anyone who wants to be ready to help someone in need. Bleeding control kits can be purchased online at many retailers. These kits contain the supplies necessary to help stop the bleeding in emergencies and are perfect to have in the car, home, and workplace.
These topical agents are lifesaving tools that can help stop uncontrolled bleeding after an accident or in a surgical setting. Be ready to act in trauma situations and help improve survival rates for victims of traumatic bleeding.
