Antihemorrhagic

Short description: Substance that stops bleeding

An antihemorrhagic (British English: antihaemorrhagic) agent is a substance that promotes hemostasis (stops bleeding).[1] It may also be known as a hemostatic (also spelled haemostatic) agent.[2]

Antihemorrhagic agents used in medicine have various mechanisms of action:

* Systemic drugs work by inhibiting fibrinolysis or promoting coagulation.
* Locally acting hemostatic agents work by causing vasoconstriction or promoting platelet aggregation.

## Contents

* 1 Medical uses
* 2 Types
* 2.1 Systemic
* 2.2 Local
* 2.2.1 Organic
* 2.2.1.1 Microfibrillar collagen
* 2.2.1.2 Chitosan
* 2.2.2 Inorganic
* 2.2.2.1 Contact activation
* 2.2.2.2 Styptics
* 3 See also
* 4 References

## Medical uses

Hemostatic agents are used during surgical procedures to achieve hemostasis and are categorized as hemostats, sealants and adhesives. They vary based on their mechanism of action, composition, ease of application, adherence to tissue, immunogenicity and cost. These agents permit rapid hemostasis, better visualization of the surgical area, shorter operative times, decreased requirement for transfusions, decreased wound healing time and overall improvement in patient recovery time.[3]

## Types

### Systemic

There are several classes of antihemorrhagic drugs used in medicine. These include antifibrinolytics, blood coagulation factors, fibrinogen, and vitamin K.[4]

### Local

Topical hemostatic agents have been gaining popularity for use in emergency bleeding control, especially in military medicine. They are available in three forms—as a granular powder poured on wounds, as a "styptic pencil"[5] or embedded in a dressing.[6]

#### Organic

##### Microfibrillar collagen

Microfibrillar collagen hemostat (MCH) is a topical agent composed of resorbable microfibrillar collagen. It attracts platelets and allows for the formation of a blood clot when it comes into contact with blood. Unlike the hemostatic clamp, no mechanical action is involved. The surgeon presses the MCH against a bleeding site, and the collagen attracts and helps with the clotting process to eventually stop bleeding.[7]

The practical application for MCH is different from that of the hemostatic clamp.[8]

##### Chitosan

Chitosan hemostats are topical agents composed of chitosan and its salts. Chitosan bonds with platelets and red blood cells to form a gel-like clot which seals a bleeding vessel. Unlike other hemostat technologies its action does not require the normal hemostatic pathway and therefore continues to function even when anticoagulants like heparin are present.[9]

Chitosan is used in some emergency hemostats which are designed to stop traumatic life-threatening bleeding. Their use is well established in many military and trauma units.[10]

#### Inorganic

##### Contact activation

Kaolin (and the zeolite in it) activate the coagulation cascade, and have been used as the active component of hemostatic dressings (for example, in QuikClot).[11]

##### Styptics

Styptic pencil

Alum block and razor

A styptic (also spelled stiptic) is a specific type of antihemorrhagic agent that works by contracting tissue to seal injured blood vessels. Styptic pencils contain astringents.[12]

A common delivery system for this is a styptic or hemostatic pencil (not to be confused with a caustic pencil). This is a short stick of medication. Anhydrous aluminium sulfate is the main ingredient and acts as a vasoconstrictor in order to disable blood flow. The stick is applied directly to the bleeding site. The high ionic strength promotes flocculation of the blood, and the astringent chemical causes local vasoconstriction. Before safety razors were invented, a styptic pencil was a standard part of a shaving kit and was used to seal shaving cuts.[13] Some people continue to use styptic pencils for minor skin wounds from safety or electric razors.[13]

Styptic powder is used in the veterinary trade to stop bleeding from nails that are clipped too closely. This powder is generally used on animals, such as cats, dogs, and rabbits, whose vein is found in the center of the nail.[14]

## See also

* ATC code B02 – Antihemorrhagics
* Hemostatic clamp
* Hemostatic Powder Spray TC-325

## References

1. ↑ "antihemorrhagic" at Dorland's Medical Dictionary
2. ↑ "hemostat" at Dorland's Medical Dictionary
3. ↑ Vyas, Krishna S; Saha, Sibu P (22 October 2013). "Comparison of hemostatic agents used in vascular surgery". Expert Opinion on Biological Therapy 13 (12): 1663–1672. doi:10.1517/14712598.2013.848193. PMID 24144261.
4. ↑ (in en) Pharmacology ReCap 2.0 for Bachelor of Dentistry Students. Quick Review of Pharmacology. https://books.google.com/books?id=_1rzHhxfrdoC.
5. ↑ Styptic Pencil (definition)
6. ↑ "When to use hemostatic agents in EMS". http://www.ems1.com/medical-clinical/articles/2156227-When-to-use-hemostatic-agents-in-EMS/.
7. ↑ Sundaram, Chandru P.; Keenan, Alison C. (2010-01-01). "Evolution of hemostatic agents in surgical practice". Indian Journal of Urology 26 (3): 374–378. doi:10.4103/0970-1591.70574. ISSN 0970-1591. PMID 21116358.
8. ↑ Dong, Shaosheng (Nov 6, 2014), Film forming personal care compositions and methods, http://www.google.com/patents/US20140328776, retrieved 2016-03-14
9. ↑ Millner, Russell; Lockhart, Alan S; Marr, Rebecca (2010-10-01). "Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation". Annals of the Royal College of Surgeons of England 92 (7): 559–561. doi:10.1308/003588410X12699663903593. ISSN 0035-8843. PMID 20522310.
10. ↑ "Military Experts Say Newer Hemostatic Dressings Beat Gauze // ACEP". http://www.acep.org/Clinical
Practice-Management/Military-Experts-Say-Newer-Hemostatic-Dressings-Beat-Gauze/.
11. ↑ "HOW QUIKCLOT BRAND PRODUCTS WORK TO STOP BLEEDING". Z-Medica Corporation. http://www.z-medica.com/ZMedica/files/be/be74177f-1146-495b-999d-f1f5e1fa1835.pdf.
12. ↑ "astringent" at Dorland's Medical Dictionary
13. ↑ 13.0 13.1 "Styptic Pencil what is it, how to use at Executive Shaving". Executive-shaving.co.uk. 2015-08-21. http://www.executive-shaving.co.uk/shavepedia/Styptic_Pencil.
14. ↑ "Pet first-aid kit contents". http://www.vet.cornell.edu/news/articles/09petfirstaid.cfm.

* v
* t
* e

Antihemorrhagics (B02)

Antihemorrhagic|

| Systemic|

| Vitamin K|

* Phytomenadione (K1)
* Menadione (K3)

|

Coagulation
factors|

* intrinsic: IX/Nonacog alfa
* VIII/Moroctocog alfa/Turoctocog alfa

* extrinsic: VII/Eptacog alfa

* common: X
* II/Thrombin
* I/Fibrinogen
* XIII/Catridecacog

* combinations: Prothrombin complex concentrate (II, VII, IX, X, protein C and S)

Other
systemic|

* Batroxobin
* Carbazochrome
* Etamsylate
* Fostamatinib
* thrombopoietin receptor agonist
* Romiplostim
* Avatrombopag
* Eltrombopag
* Lusutrombopag

Local|

* Absorbable gelatin sponge
* Oxidized cellulose
* Tetragalacturonic acid hydroxymethylester
* Thrombin
* Collagen
* Calcium alginate
* Epinephrine/Adrenalone

Antifibrinolytics|

* amino acids
* Aminocaproic acid
* Tranexamic acid
* Aminomethylbenzoic acid
* serpins
* Aprotinin
* Alfa1 antitrypsin
* C1-inhibitor
* Camostat
* unsorted
* Ulinastatin

* v
* t
* e

Pharmacology: major drug groups

Gastrointestinal tract/
metabolism (A)|

* stomach acid
* Antacids
* H2 antagonists
* Proton pump inhibitors
* Antiemetics
* Laxatives
* Antidiarrhoeals/Antipropulsives
* Anti-obesity drugs
* Anti-diabetics
* Vitamins
* Dietary minerals

Blood and blood
forming organs (B)|

* Antithrombotics
* Antiplatelets
* Anticoagulants
* Thrombolytics/fibrinolytics
* Antihemorrhagics
* Platelets
* Coagulants
* Antifibrinolytics

Cardiovascular
system (C)|

* cardiac therapy/antianginals
* Cardiac glycosides
* Antiarrhythmics
* Cardiac stimulants
* Antihypertensives
* Diuretics
* Vasodilators
* Beta blockers
* Calcium channel blockers
* renin–angiotensin system
* ACE inhibitors
* Angiotensin II receptor antagonists
* Renin inhibitors
* Antihyperlipidemics
* Statins
* Fibrates
* Bile acid sequestrants

Skin (D)|

* Emollients
* Cicatrizants
* Antipruritics
* Antipsoriatics
* Medicated dressings

Genitourinary
system (G)|

* Hormonal contraception
* Fertility agents
* SERMs
* Sex hormones

Endocrine
system (H)|

* Hypothalamic–pituitary hormones
* Corticosteroids
* Glucocorticoids
* Mineralocorticoids
* Sex hormones
* Thyroid hormones/Antithyroid agents

Infections and
infestations (J, P, QI)|

* Antimicrobials: Antibacterials (Antimycobacterials)
* Antifungals
* Antivirals
* Antiparasitics
* Antiprotozoals
* Anthelmintics
* Ectoparasiticides
* IVIG
* Vaccines

Malignant disease
(L01–L02)|

* Anticancer agents
* Antimetabolites
* Alkylating
* Spindle poisons
* Antineoplastic
* Topoisomerase inhibitors

Immune disease
(L03–L04)|

* Immunomodulators
* Immunostimulants
* Immunosuppressants

Muscles, bones,
and joints (M)|

* Anabolic steroids
* Anti-inflammatories
* NSAIDs
* Antirheumatics
* Corticosteroids
* Muscle relaxants
* Bisphosphonates

Brain and
nervous system (N)|

* Analgesics
* Anesthetics
* General
* Local
* Anorectics
* Anti-ADHD agents
* Antiaddictives
* Anticonvulsants
* Antidementia agents
* Antidepressants
* Antimigraine agents
* Antiparkinson agents
* Antipsychotics
* Anxiolytics
* Aphrodisiacs
* Depressants
* Entactogens
* Entheogens
* Euphoriants
* Hallucinogens
* Psychedelics
* Dissociatives
* Deliriants
* Hypnotics/Sedatives
* Mood Stabilizers
* Neuroprotectives
* Nootropics
* Neurotoxins
* Orexigenics
* Serenics
* Stimulants
* Wakefulness-promoting agents

Respiratory
system (R)|

* Decongestants
* Bronchodilators
* Cough medicines
* H1 antagonists

Sensory organs (S)|

* Ophthalmologicals
* Otologicals

Other ATC (V)|

* Antidotes
* Contrast media
* Radiopharmaceuticals
* Dressings
* Senotherapeutics

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