Hemostatic agents

Types

Plant-Based	Oxidized cellulose (OC) and oxidized regenerated cellulose (ORC)
Gelatin-based	Purified pork or bovine skin; absorbs 45 times its weight of its initial volume causing hemostasis. Excessive swelling can lead to nerve compression
Collagen-based	Derived from tissue; shows cell compatibility, adhesion, growth and migration.
Fibrin-based	High concentrations of fibrinogen, thrombin and additional components (clotting factors)
Thrombin-based	Directly participate in the coagulation cascade process that promotes and modulates coagulation. Provides a lattice for platelet aggregation and thrombus formation.
Chitin-based	Polysaccharide biopolymer produced naturally by algae through fermentation. Also known as chitosan in its deacetylated form. Chitosan has been shown to be more effective that chitin in controlling severe hemorrhage.

Characteristics

Charateristic	QuikClot ACS+	HemCon	Celox	WoundSat	Combat Gauze
Hemostatic efficacy	+	+	+++	++++	++++
Side effects	No	No	No	Yes	No
Ready to use	Yes	Yes	Yes	Yes	Yes
Training requirement	+	+	+	+++	++
Lightweight, durable	+	+++	+++	+	+++
2-year shelf life	Yes	Yes	Yes	Yes	Yes
Stable in extreme conditions	Yes	Yes	Yes	Yes	Yes
Cleared by FDA	Yes	Yes	Yes	Yes	Yes
Biodegradable	No	No	Yes	No	No
Cost ($)	~30	~75	~25	~30	~25

Use

• For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze
• Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available.
• Hemostatic dressings should be applied with at least 3 minutes of direct pressure.

See Also

• Bleeding treatments
• Tactical combat casualty care

References

Authors

Ross Donaldson, Michael Holtz, Daniel Ostermayer