Gabay, M. (2006). Absorbable hemostatic agents. American Journal of Health-System Pharmacy, 63, 1244–1253.

DOI Link

Purpose & Patient Population

PURPOSE: To review absorbable hemostatic agents including pharmacology, clinical efficacy, adverse events and toxicities, dosage and administration, and safety issues

Results Provided in the Reference

Discusses nine different agents and the different composition of each (e.g., porcine or bovine gelatin, bovine collagen or oxidized cellulose). The two newest agents (approved as U.S. Food and Drug Administration devices, not drugs) are FloSeal® and CoStasis®, and these products include bovine thrombin.

Guidelines & Recommendations

  • Absorbable agents provide hemostasis via contact activation (which initiates clotting) and/or promotion of platelet aggregation.
  • Absorbable hemostatic agents are indicated for use during surgery when bleeding can not be controlled by conventional methods such as pressure.
  • Emphasis that topical thrombin is for TOPICAL application only. Misadministration (e.g., IV) can be fatal.

Limitations

  • Literature on these agents is mostly case reports. There are few well-controlled trials that actually have compared agents and/or the efficacy of such agents specifically in instances of bleeding associated with malignancy. The summary of trials and reports is presented. Only 2 of the 14 trials had patients with cancer in the sample (patients with hepatocellular carcinoma undergoing elective hepatic resection and patients with gynecologic cancer undergoing exploratory laparotomy).
  • Allergic reactions to thrombin can occur, as can development of antibodies to bovine components of the product.
  • No standardized dosing regimens exist; the minimal amount of product needed to achieve hemostasis should be used. Follow product labeling, especially for newer agents such as FloSeal (Baxter) and CoStasis (Cohesion Technologies). A summary table for dosage and administration per each agent is provided.
  • Good clinical data are lacking evaluating efficacy of these agents, especially for off-label use (e.g., in nasal packing for uncontrolled epistaxis in patients with thrombocytopenia).