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. 2018 Aug 29;18(1):68.
doi: 10.1186/s12893-018-0398-z.

A systematic review on the use of topical hemostats in trauma and emergency surgery

Osvaldo Chiara  1 , Stefania Cimbanassi  2 , Giovanni Bellanova  3 , Massimo Chiarugi  4 , Andrea Mingoli  5 , Giorgio Olivero  6 , Sergio Ribaldi  7 , Gregorio Tugnoli  8 , Silvia Basilicò  9 , Francesca Bindi  9 , Laura Briani  9 , Federica Renzi  9 , Piero Chirletti  10 , Giuseppe Di Grezia  11 , Antonio Martino  12 , Rinaldo Marzaioli  13 , Giuseppe Noschese  14 , Nazario Portolani  15 , Paolo Ruscelli  16 , Mauro Zago  17 , Sebastian Sgardello  9 , Franco Stagnitti  18 , Stefano Miniello  19
Affiliations

A systematic review on the use of topical hemostats in trauma and emergency surgery

Osvaldo Chiara et al. BMC Surg. .

Abstract

Background: A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient's coagulation status.

Methods: The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held.

Results: Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient's coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective.

Conclusions: Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.

Keywords: Emergency surgery; Fibrin adhesives; Hemorrhage; Hemostatic dressings; Hemostats; Mechanical hemostats; Sealants; Systematic review; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

Local ethics committee (Azienda Socio Sanitaria Territoriale-Grande Ospedale Metropolitano Niguarda-ASST GOMN; Coordinator prof Bruno Cesana, MD) ruled that no formal ethics approval was required for the current study because no involvement of patients or therapeutic interventions.

Consent for publication

not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Bibliography search (PRISMA). This figure represents the methodology applied to screen abstract and papers, in order to identify relevant papers to be used for manuscript preparation
Fig. 2
Fig. 2
Decisional pathway to choose topical hemostats. This figure represents criteria to be applied in order to correctly select the topical hemostats according to clinical setting and patient characteristcs
See this image and copyright information in PMC

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