Editing Haemostasis (section)

== '''Stopping bleeding - graded approach''' ==

* Physicochemical methods
** Gauze pack
** Topical:
*** Passive
**** Surgicel - $ - oxidised regenerated cellulose - can cause foreign body reaction, infection, adhesions. Works well if just minimal bleeding. Expect to absorb in 14 days.
**** Gelfoam - gelatine sponge
**** Bone wax - $ - physically occludes bleeding vessels - use a minimal amount.
*** Active
**** Tisseel - fibrin sealant - $$$$ - human fibrinogen and thrombin - liquid. Needs to be mixed just prior to use.
**** Floseal - $$ - gelatine and bovine thrombin complex - for active bleeding
**** Surgiflo - $$ - gelatine and porcine thrombin
**** Tranexamic acid - inhibits activation of plasminogen to plasmin
**** TachoSil - equine collagen sponge coated with fibrinogen and thrombin
*** Tissue adhesives
** For minor ooze, surgicel is sufficient. For ongoing but mild bleeding, floseal should do the job. For ongoing bleeding, or in the coagulopathic patient, Tisseel may be necessary, but it is expensive.