Agent | Source | How supplied | Trade names in United States | Absorption time[1] | Adverse effect*[2] | Relative expense¶[1,3] |
Physical agents | ||||||
Wax-based | ||||||
Bone wax | Beeswax | Stick form | Not applicable | Indefinite | Impaired bone healing | ¢ |
Ostene (soluble copolymer implant material) | Synthetic alkaline oxide copolymers | Stick form | Ostene | 48 hours | ¢ | |
Dry matrix | ||||||
Absorbable gelatin (gelatin matrix) | Porcine | Sponge, powder | Gelfilm, Gelfoam, Surgifoam, Gelfoam hemostasis kit (also contains human thrombin) | 4 to 6 weeks | Infection, abscess or granuloma formation, fibrosis, clot disruption if sponge is removed[1] | $ |
Oxidized regenerated cellulose | Plant | Mesh | Surgicel (Nu-Knit, Fibrillar, SNoW) | 1 to 2 weeksΔ | Foreign body reaction, infection, adhesions[1] | $ |
Microfibrillar collagen (collagen hemostat) | Bovine | Sheets | Actifoam, Avitene (Ultrafoam), Endo Avitene, Instat MCH, Helistat Helitene, Syringe Avitene | >8 weeks | Granuloma formation, allergenic | $$ |
Powder | Avitene Flour | |||||
Microporous polysaccharide spheres (MPH) | Synthetic | Powder | Arista AH | 24 to 48 hours | Use of >50 g can alter glucose load in patients with diabetes | $ |
External agents | ||||||
Chitosan | Biodegradable complex carbohydrate derived from chitin | Adhesive dressing | HemCon bandage (Chitoflex) | Not applicable | Training needed to ensure proper application | ¢ |
Kaolin-impregnated sponge | Aluminosilicate mineral | Gauze sponge | Quikclot | Not applicable | Possible clot disruption when sponge removed | ¢ |
Hemafiber | Cellulose and silica | Dressing, surgical pad, elastic wrap | NuStat OTC, NuStat Trauma Pad XR, NuStat Flex | Not applicable | Possible clot disruption when pad removed | $ |
Biologically active agents | ||||||
Topical thrombin | Bovine | Liquid | Thrombin-JMI | Not applicable | Intravascular application leads to thrombosis Antibody formation against bovine thrombin can inhibit coagulation and prolong prothrombin time/INR | $$ |
Human | Evithrom | |||||
Recombinant human (rHuman) | Recothrom | |||||
Fibrin sealant (human fibrinogen and human thrombin)◊ | Human | Liquid | Artiss, Tisseel (also contains synthetic aprotinin), Evicel, TachoSil, Evarrest, Vistaseal | Immediate | Potential exposure to blood-borne viruses | $$$ |
Human autologous | CryoSeal Fibrin Sealant System Vitagel (autologous fibrinogen and bovine thrombin) | Not available | ||||
Human | Powder (spray and direct application; for use with absorbable gelatin sponge) | Raplixa | (Refer to Absorbable gelatin sponge, above) | Not available | ||
Dry Fibrin Sealant Dressing (DFSD)§ | Freeze-dried fibrinogen and thrombin applied to gauze substrate | Dressing | Not applicable | Not applicable | $$$$ | |
Bovine albumin-glutaraldehyde tissue adhesive | Bovine | Liquid | Bioglue | Antibody formation against bovine thrombin can inhibit coagulation and prolong prothrombin time/INR | $$$$ | |
Combination preparations | ||||||
Thrombin/gelatin | Bovine or porcine | Liquid | Floseal (bovine), Surgiflo (porcine) | 6 to 8 weeks | Antibody formation against bovine thrombin can inhibit coagulation and prolong prothrombin time/INR | $$$ |
Thrombin/collagen | Bovine | Liquid | Costasis | 4 weeks | Antibody formation against bovine thrombin can inhibit coagulation and prolong prothrombin time/INR | $$$ |
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