ADJUNCTIVE HEMOSTATIC AGENTS
CLINICAL PRACTICE GUIDELINES
Hemophilia and von Willebrand’s Disease: 2. Management
(Edition 2, Update 2 [1999-07-07])
When used properly, the following types of adjunctive agents can promote hemostasis and reduce the amount of blood product required.
• Antifibrinolytic agents such as e-aminocaproic acid (Amicar) and tranexamic acid (Cyklokapron). These products inhibit plasminogen activation and plasmin activity, thus preventing clot lysis. They are best used for the treatment of mucosal, oral and dental bleeds including prophylaxis for dental extractions <11,57-59> (Table 2 below). A short course (5 days) of antifibrinolytic therapy (Amicar 50-75 mg/kg [up to 4 g] every 6 hours or Cyklokapron 25 mg/kg every 8 hours) is also effective in the management of epistaxis and menorrhagia. These agents should not be used to treat urinary tract hemorrhage, in which an unlysed clot may cause urinary tract obstruction, or bleeding into a closed space where hemostatic monitoring is difficult. Antifibrinolytics can be administered orally, intravenously or topically for oral and dental bleeds, and for epistaxis.
• Topical thrombin and fibrin sealant. These agents are useful for the control of localized, accessible bleeding from lacerated tissues or after dental extraction, particularly when blood products are not effective (e.g., when inhibitors have developed). Bovine thrombin powder can be applied directly or on a gelatine sponge. The development of antibodies against thrombin, factor V and fibrinogen resulting in bleeding has been reported in patients exposed during surgery to bovine thrombin (a component of both topical thrombin and fibrin sealant).<60-63>
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