Diagram from: Operative Hemostasis in Trauma and Acute Care Surgery: The Role of Biosurgical Agents
Common end stage is conversion of factor X to Xa
Activation of thrombin from prothrombin, and fibrin from fibrinogen, to form a stable fibrin clot
Stable fibrin clot stabilises the initial platelet plug
| Passive agents without active haemostatic agents | |
| Surgicel
Fibrillar SNoW Arista
|
Absorbable cotton with oxidised regenerated cellulose (i.e. just a matrix without biological substance)
Passive haemostasis – requires patient to have their own intact clotting system No animal or human products |
| Surgiflo
|
Porcine derived gelatin without biological substance
(can be used with thrombin also) |
| Active haemostatic agents | |
| Floseal | Bovine (cow) derived gelatin matrix, with human derived thrombin
Good in wet field Requires active bleeding to work Creates gelatin reinforced blood clot Good for localised bleeding
Requires time and drawn out process to prepare to be ready |
| Tisseel | Fibrin glue – human fibrinogen and thrombin derived from plasma
Replicates end stage of clotting cascade Requires dry field Good for diffuse oozing blood |
| Tachosil | Fibrin pad – human fibrinogen and thrombin, with equine collagen
Contact application, and replicates end stage of clotting cascade OK in moist field Good for diffuse oozing blood |
Managing Jehovah’s Witnesses:
- Clear explanation about different blood products that may be required and risks of using and not using them
- Clear documentation which products the patient will and will not accept
- Check Hb pre-operatively, optimise with iron if needed (?EPO)
- Separate checklist outlining which products are acceptable – reviewed at time of sign-in and timeout
- Majority of JW’s accept cell saver
- Guidance from head office suggests haemostatic agents made from recombinant blood with further processing – i.e. Floseal, fibrin glue (Tisseel) and fibrin pads (Tachosil) are OK – as well as cryoprecipitate/prothrombinex – but a matter for individual choice
- Tranexamic acid should be considered and used