Haemostyptica and anticoagulants

[Vorenus]

So, the title tells the most of it.

Around here, we don`t use haemostyptica, if`ve stumbled across it lately again, and was wondering in what extent the outcome of haemostyptica would be influenced by a prior medication of anticoagulants by the patient.

I`ve been already searching the web a bit, but couldn`t seem to find anything viable.

So has anybody experiences with that topic? Maybe some studies to point forward?

[DwayneEMTP]

Unless you mean that little white pencil thing that you stick in the hole made by a shaving cut to stop the bleeding...I've got nothing....

Wait, even if that IS what you mean...I still have nothing...

Sorry Brother...

So, then why did I reply you might ask?

Well...not sure...still got nothing...complete vacuum here....

Dwayne

[Vorenus]

LOL!

It`s okay, bro.

[Just Plain Ruff]

Try this

https://www.google.com/#hl=en&sa=X&ei=1sbeTpO9MMPO2wWO0qmrBQ&ved=0CCUQBSgA&q=hemostyptic+and+anticoagulants&spell=1&bav=on.2,or.r_gc.r_pw.r_cp.,cf.osb&fp=cd745cb8d1c06a57&biw=1366&bih=599

[Bernhard]

Ask a German Bundeswehr army medic, maybe he/she can provide you with more information and maybe an example (as my friend did): they use QuikClotACS+[TM] from Z-Medica Corporation, Wallingford CT/USA, see their WWW page at www.z-medica.com for more information (includes video). European representant is EMERGO Europe, Den Haag, german office here: EMERGO DEUTSCHLAND GMBH, Poststrasse 33, 20354 Hamburg, Germany, Phone: +49 (0) 40 2261 1652 (no german homepage, though).

On the Z-Medica homepage there are several study abstracts available, mentioning anti-coagulated patients. Plus the contact address of their Chief Medical Officer for medical professionals with further questions.

EDIT: added last paragraph.

Edited December 10, 2011 by Bernhard

[Vorenus]

Thanks both of you.

Bernhard, does anyone in your area uses haemostyptca, btw? The only time I heard about the use of haemostyptica in a civilian setting in Germany was somehow connected to Bavaria (think it was a former colleague who did this training there).

[Bernhard]

Bernhard, does anyone in your area uses haemostyptca, btw?

Not in my area and not in those nearby I know. We're thinking of adding it to our disaster response equipment, but we're still far away from realizing it. In military combat situations it's commonly used, but mostly on otherwise healthy young people (soldiers). In german EMS I don't know anyone even considering it (other than you and me), can't remember any article or conference topic about it.

We usually have not that much deep chest/abdominal wounds, where I think would be the main indication. Explosive or gun shot wounds and stabbings are very rare in Germany. However, I simply would like to have the additional option.

[DwayneEMTP]

Wait just a second....I know what you're talking about now!!

But no, don't use it here not anywhere that I've worked other than Afg...

Dwayne

[DFIB]

We do not use it here but I tried a demonstration on a pig once. The pig was not on coumadin. Works pretty well. I have seen it used in plastic surgery with good success.

A surgeon friend says he tried it on lacerated liver with very poor results. He said it "burned" the internal organs and only recommends it for peripheral bleeds.

[Aussieaid]

There are a few brands around and the one that probably "burned" the internal organs (It's not intended to put directly onto internal organs!) may have been Quik clot which used to contain Zeolite beads that caused an exothermic reaction but now they contain Kaolin instead which doesn't burn. There is also Celox and a few other hemostatic agents about. You can get them in powder, granules or impregnated gauze forms. We used to use another version called Surgicel in the hospital when we had wounds that wouldn't stop bleeding or an anticoagulated patient. That worked really well and can be used for internal bleeding too.

The failures with the products usually were caused by incorrect application. Once it is applied you need to maintain pressure for 5 minutes or so and then not disturb the clot that has formed. However I think when you have something as severe as a traumatic amputation the tourniquet is probably more effective. I have used it in a traumatic amputation but it is hard to maintain consistent pressure on a large area when transporting. It is good for severe lacerations or heavily bleeding wounds though (especially scalp wounds) and I have had success with it a number of times in the civilian setting.

The latest success I had with a hemostatic agent was for a severe epistaxis that had lasted a couple of days and multiple treatments had been unsuccessful in stopping the bleeding. We used Combat gauze to pack the nose. That was what eventually stopped the bleeding and he didn't require evacuation out of theater after all. This patient had been on high dose ASA for 18 years.