Hemorrhage is the leading cause of
trauma-related deaths. The early identification and surgical control of this
hemorrhage is the crucial first step in the management of the injured patient; however, this objective remains challenging in the most
critically ill trauma patients. As an adjunct to traditional methods of
surgical hemorrhage control, several advanced
hemostatic agents are currently available.
Oxidized cellulose,
fibrin glue and synthetic adhesives constitute the first-line of local
hemostatic agents. Materials such as
Zeolite and
Chitosan comprise the newest generation of local
hemostatics and the efficacy and safety of these agents are currently under investigation.
Recombinant factor VIIa has emerged recently as a promising systemic
hemostatic adjunct for the treatment of intractable surgical
bleeding; however, until completion of the ongoing multinational randomized control trial, the indications for its use in
trauma patients and its safety profile are unclear. This article reviews the role of commercially available local and systemic
hemostatic products in the
trauma patient population; it also addresses the unique set of characteristics, indications, limitations and rationale for their use.