Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Article Compares Hemostatic Agents: Are There Any Differences?

Once of the major recent advances in trauma care has been the evolution of topical substances that can be applied to wounds in order to limit or stop hemorrhage (bleeding). This is very important in wilderness medicine, because uncontrolled bleeding is a leading cause of death from injuries. When the bleeding site can be approached in such a manner as to stop the bleeding, then something very valuable may possibly be done for the patient.

In article entitled “Comparison of Celox-A, ChitoFlex, WoundStat, and Combat Gauze Hemostatic Agents Versus Standard Gauze Dressing in Control of Hemorrhage in a Swine Model of Penetrating Trauma,” Lanny Littlejohn, MD and colleagues used an animal model of a complex groin injury with a small penetrating wound, followed by completely cutting the femoral artery and vein, to determine whether there was any benefit to one or another hemostatic (stops bleeding) agent in comparison to each other and to standard gauze dressing. To cut to the chase (no pun intended), the results showed that no difference was found among the agents with respect to initial cessation of bleeding, rebleeding, and survival. In this study, WoundStat was inferior with respect to initial cessation of bleeding and survival when compared to Celox-A.

The authors point out how important it is to control severe bleeding early in the course of a patient’s therapy, because at a certain point, bleeding leads to organ failure and a vicious cycle of severe acid-base imbalances, more bleeding, and the complications that might occur from blood transfusions. The different hemostatic agents, be they free granules poured into a wound or gauze impregnated with active substances, need to be readily available, easy to deploy, effective in a short period of time, not painful, and without complications. There are more than a few agents that fit the bill, so it’s important to be objective about the pros and cons of each agent. In this study, it was confirmed that they all work roughly equally effectively, so the choice often comes down to comfort of the user with a particular product and personal preferences.

What was surprising as an outcome in the study was the observation that a standard (nonmedicated) gauze dressing was as effective as any of the hemostatic agents. That contradicts some of the current rhetoric that I have heard at medical meetings from experts on wound care, who are beginning to swear by the use of hemostatic agents. If it is true that there are circumstances in which hemostatic agents do not add any benefit to the clinical process of stopping or limiting bleeding, we need to know, so that we don’t waste precious time and money deploying these agents. Obviously, if these agents are beneficial, we need to know about that as well.

A practical observation of this particular study was that a rolled, impregnated (with hemostatic agent) gauze introduced into a bleeding wound should first be unrolled prior to application, to avoid creating a congealed mass of gauze and blood that cannot be properly manipulated and positioned within the confines of the wound.

This post, Article Compares Hemostatic Agents: Are There Any Differences?, was originally published on by Paul Auerbach, M.D..

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles