|September 2008 · Vol. 20, No. 09
Update on Technology
Topical hemostasis agents: Some tried and true, others too new
Topical thrombin isn’t for use in postpartum bleeds, infection, or menorrhagia
Tissue sealants have hemostatic properties, but they haven’t been tested on gyn patients
Board of Editors, OBG Management
Dr. Levy is Medical Director of the Women’s Health Center, Franciscan Health System, Federal Way, Wash. She will be a member of the faculty at the Symposium on Controversies and Dilemmas in Women’s Health, October 11, 2008, at the Duke Energy Center, Cincinnati, Ohio (www.controversiesinwomenshealth.org).
The author reports no financial relationships relevant to this article.
Bleeding is a serious clinical problem during surgery—one that can have a major impact on the well-being of the patient. We generally use sutures and electrosurgical instruments—both bipolar and monopolar—to control major vessels. Topical hemostasis agents may be useful, however, in areas where generalized oozing is present, or where the application of energy may endanger vital structures.
WHAT THE EVIDENCE ABOUT THESE PRODUCTS MEANS FOR PRACTICE
Many products are available to help the ObGyn surgeon achieve hemostasis in tough situations. Most of the time, we face generalized oozing after treatment of extensive endometriosis or adhesiolysis; in these cases, older topical agents should serve us well. Patients who experience massive bleeding are not likely to benefit from the use of any of the products described in this article.
Extensive bleeding from uterine incisions—at cesarean section or after myomectomy—might respond to topical thrombin, platelet gel products, or tissue sealants, but these products have not been studied in our patients. They also are expensive and carry some risk for our patients.
Don’t overlook two strategies for extremely high-risk situations:
Cell-saver technology can help avert transfusion in patients expected to lose a substantial amount of blood
Intravenous recombinant activated factor VII (NovoSeven) can be life-saving for women who experience postpartum hemorrhage, placenta percreta, or retroperitoneal sarcoma and for whom our standard strategies have failed.—BARBARA S. LEVY, MD