Thrombostatic Agents and Tissue Adhesives in the Emergency Department: Stopping the Bleeding, Closing the Wound, and Novel Applications

Abstract

Complaints of bleeding are frequent presentations to the emergency department, and although most bleeding can be controlled with direct pressure, increased use of antiplatelet agents and anticoagulants complicates what might be otherwise simple bleeding. Industry has met the demand for hemostatic adjuncts, and a number of products are available for the emergency physician to assist in hemostatic control and wound closure. This chapter will cover the various available technologies, covering their preferred use and discussing particular bleeding scenarios and which technology may be best for each scenario.

Advances in Topical Hemostatic Agent Therapies: A Comprehensive Update

“…Cyanoacrylates need no follow-up visit for suture removal and provide a waterproof barrier. Octyl-2-cyanoacrylate does not show any difference in the incidence of infection, dehiscence, or cosmetic appearance when repairing lacerations as compared to standard sutures, staples, or adhesive strips [34,35]. It is safe to use cyanoacrylates for wounds, lacerations, and minimal incisions (e.g., laparoscopy).…”

“…Cyanoacrylates form polymers from liquid monomers in the presence of water to glue adjacent surfaces together. Octyl-2-cyanoacrylate (such as Dermabond) was initially developed to repair combat wounds, and the embolization of portosystemic venous shunts, pseudoaneurysm anastomoses, arteriovenous fistulas, vascular reconstructions, and cardiac surgery [33][34][35]. Butyl-2-cyanoacrylate was developed in Asia for the embolization of gastric and esophageal varices by direct injection into the bleeding vessels.…”

Tissue Adhesives in Reconstructive and Aesthetic Surgery—Application of Silk Fibroin-Based Biomaterials

“…Fibrin is a physiological component of human blood and an essential factor in secondary hemostasis [ 12 ]. Products have been commercially available in Europe since 1972 [ 43 , 44 ]. Adhesives consist of two separate components: Thrombin (Factor IIa) and Calcium (Factor IV) as well as Factor VIII and Fibrinogen [ 12 ].…”