This document summarizes various hemostatic agents and tissue sealants used in surgery. It discusses collagen products, oxidized regenerated cellulose, gelatin sponges, flowable gelatins, thrombin, and fibrin sealants. For each product, it describes the composition, mechanisms of action, advantages, disadvantages, and differences between brands. The document provides an overview of the history and development of hemostatic agents over the past century.

1. Use of Tissue Sealants and Hemostatic Agents in Surgery Martha K. Terris, M.D. Medical College of Georgia

2. Hemostasis “life in the balance” CVA MI DVT PE Trauma Surgery Anticoagulation Hemophilia Bleeding to Death Clotting to Death

5. A Century of Hemostasis Surgeons today have an impressive set of tools to manage intra-operative bleeding. But how do you know what to use? 1900 1950 2000 Clamps Clips Sutures Direct Compression Bone wax Electrocautery Laser Argon beam ORC Gelatin Thrombin Flowable gelatin Fibrin Sealants Synthetic Sealants

12. Bleed

13. Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant

14. Bleed Platelet inhibitors, NSAIDS, ASA, Clopidogrel Thrombin inhibitors, Heparin, Warfarin tPA, uPA Trauma, Time, Us!

18. AVITENE Avitene Collagen Sponge (Absorbable Hemostat Sponge) Avitene MCH Flour (Microfibrillar Collagen Hemostat Powder)

23. $12 $15 $20

24. How Does SURGICEL Work?

25. Why is SURGICEL Bactericidal?

28. SURGICEL SURGICEL Mesh adherent to area of bleeding SURGICEL Nu-Knit used to make bolsters for partial nephrectomy

29. SURGICEL Fibrillar Can be shredded, compacted, or moistened and molded to various shapes

40. Flowable Gelatins Surgiflo

43. Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant

47. Isolation of anti-Bovine Thrombin Antibodies 1989 90 91 92 93 94 95 96 97 98 99 00 01 Clinical Reports of Patients with Major Complications from Antibodies Prospective Analysis of Thrombin Exposure in Surgical Patients Autoimmune Processes Linked with Use of Bovine Thrombin

52. Fibrin Sealants Target the Final Steps of the Coagulation Cascade

55. Bleed Collagen, ORC Flowable Gelatin Thrombin Fibrin Sealant

58. Tisseel

59. Evicel

60. Tisseel

68. “ All Bleeding Stops”