J Trauma Acute Care Surg. 2019 Oct 14;Epub ahead of print

# A Comprehensive Review of Topical Hemostatic Agents: The Good, The Bad, and the Novel.

Tompeck A, Gajdhar A, Dowling M, Johnson S, Barie P, Winchell R, King D, Scalea T, Britt L, Narayan M

Exsanguination remains the leading cause of preventable death for trauma patients, many of whom die in the pre-hospital setting. Without expedient intervention, trauma-associated hemorrhage induces a host of systemic responses, including the acute coagulopathy of trauma. For this reason, healthcare providers and pre-hospital personnel face the challenge of rapid, effective hemorrhage control. The utilization of adjuncts to facilitate hemostasis was first recorded in 1886. Commercial products have since expanded to include topical hemostats, surgical sealants, and adhesives. The ideal product balances efficacy, safety, practicality, and cost-effectiveness. This review of hemostatic agents provides a guide for successful implementation and simultaneously highlights future opportunities.