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Review
. 2023 May;19(2):247-253.
doi: 10.1177/15563316221134270. Epub 2022 Nov 14.

Hemostatic Agents in Orthopedic Surgery

Kira K Tanghe  1 , Brian P Chalmers  2 , Jason L Blevins  2 , Mark P Figgie  2 , Alberto V Carli  2 , Christopher J Agrusa  3 , Peter K Sculco  2 , Elizabeth B Gausden  2
Affiliations
Review

Hemostatic Agents in Orthopedic Surgery

Kira K Tanghe et al. HSS J. 2023 May.

Abstract

Controlling blood loss is a crucial aspect of orthopedic surgery. Hemostatic agents can be used intraoperatively in combination with antifibrinolytics as part of an overall strategy to limit blood loss. Several new hemostatic agents have recently come to the market designed specifically for vascular surgery but have found uses in other surgical fields, including orthopedics. This article reviews the mechanisms of action and best uses of various mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants for achieving hemostasis in orthopedic surgery. Mechanical and active hemostats have been reported to successfully decrease blood loss from cancellous bone, capillaries, and venules. Flowable hemostats are generally favorable for use in small spaces where the swelling capabilities of mechanical and active hemostats can be detrimental to surrounding structures. Sealants are best used for closing defects in tissues.

Keywords: blood loss; hemostasis; hemostatic agents; hemostats; orthopedics.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.L.B. reports relationships with Globus Medical, KCI, and LimaCorporate. M.P.F. reports relationships LimaCorporate, Wishbone, Insight, and Mekanika. A.V.C. reports a relationship with Heraeus Medical. P.K.S. reports relationships with DePuy/Johnson & Johnson, EOS Imaging, Intellijoint Surgical, LimaCorporate, Parvizi Surgical Innovation, and Zimmer. E.B.G. reports relationships with DePuy/Johnson & Johnson Company and Zimmer-Biomet. The other authors declare no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flowchart summarizing current best practices for hemostatic agent use in orthopedic surgeries.
See this image and copyright information in PMC

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