1 For localized small-vessel bleeding, thrombin, fibrin sealant with a surgical sponge, or thrombin with a sponge can be used. In addition, the medical and surgical history of the patient and the likelihood of reoperation must be taken into account when identifying bleeding risks and selecting appropriate topical hemostats. Other factors include the severity of the bleeding and the coagulation status of the patient. Factors to consider when selecting a topical hemostat include the type of agent, the size of the wound, and the accessibility of the bleeding site. 4 Surgical bleeding adds a number of complications to the patient, such as altered vision in the surgical field, unstable hemodynamics, increased need for blood transfusions, increased operative time, increased risk of infection, increased cost, and increased overall mortality. 3 These agents can be used for diffuse raw surface bleeding, oozing venous type bleeds, bone bleeding, and needle-hole bleeding. Topical hemostats are used intraoperatively foremost and postoperatively to a lesser extent. However, it is still important for pharmacists to be familiar with all formulary agents used within the institution. Moreover, pharmacists generally do not have a real connection with these products, as they are not in the surgical suite to see how hemostats are used in their institution. 2 Topical hemostats often get very little attention from the typical curriculum of today’s pharmacy schools. In some institutions, these products may be supplied to the operating room from the central supply and may not even be ordered or stocked by the pharmacy. There is often a knowledge gap for pharmacists with regard to topical hemostats. With demand for improved technical procedures, the use of topical hemostats may help improve outcomes. 1Ĭurrent health care has an emphasis on outcomes. These agents are applied locally to stop blood flow. Topical hemostat products include gelatin sponges, collagens, fibrin sealants, and active thrombin preparations. Topical hemostats are used in the setting of surgery or trauma as adjuncts to maintain hemostasis. Operative bleeding challenges can contribute to postoperative complications and result in additional or prolonged procedures and even increased length of stay. Surgeons face multiple bleeding challenges in the operating room.
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