Quite often in their practice, mid-level medical workers have to deal with bleeding of different localization. In particular, in children and adults - with nasal, after tooth extraction - with gums and others. Today, various hemostatic agents are used: for uterine bleeding, capillary damage to the nose and other localization. Against the background of a number of pathologies, disorders of a generalized type develop. For example, with aplastic anemia, Werlhof's disease, capillary toxicosis and others. Next, let's figure out what hemostatic drugs exist today.
General information
Why does bleeding develop? This condition is the result of a violation of integrity in large vessels or capillaries. Damage can be caused by tumor growth, trauma, insufficiency of the blood coagulation system. Often, with the appearance of an acute internal course, hemostatic drugs are administereddirectly at the scene of the incident or in the process of transporting the victim to the hospital.
Clotting factors
As observations show, against the background of internal pathologies, bleeding is caused mainly by disturbances in the coagulation system. The processes in it represent a rather complex cascade of phenomena. It involves 13 factors present in plasma, and more than ten - contained in platelets. The most important of them include: fibrinogen, prothrombin, proconvertin, contact factor and antihemophilic globulin. Due to the fibrinolytic (anti-coagulant) system, the blood is maintained in a liquid state.
Causes of violations
Bleeding in practice, as a rule, is caused either by a deficiency of a coagulation factor, for example, with viral hepatitis, mechanical jaundice, hemophilia, or a low platelet count (with Werlhof syndrome, against aplastic anemia and other pathologies). Often, the smallest numerous thromboses in the capillaries act as a trigger. They develop with further overuse of certain clotting factors and platelets. This, in turn, leads to hemorrhagic syndrome. A similar picture is noted against the background of a severe shock (cardiogenic, traumatic), poisoning, septic conditions (including after a criminal abortion), extensive operations, especially with massive blood transfusions. Previously, such a pathological condition was defined as "fibrinlytic bleeding". ATit is now referred to as intravascular disseminated microcoagulation syndrome.
Therapy Overview
Properly selected hemostatic agents for uterine bleeding, local capillary damage have an effect on the disturbed primary link of hemostasis. In general, competent therapy involves the use of one, in rare cases two, medicines in optimal dosages. For example, in hemophilic bleeding, fresh plasma infusion or the Cryoprecipitate agent is used. And drugs such as Vikasol or calcium chloride are not used in such cases. The affected link in the hemostasis system can already be determined in accordance with the anamnestic data and symptoms found during the examination of the patient. In this regard, before carrying out therapy, it is necessary to identify the genesis of the disorder. Nevertheless, topical hemostatic drugs are allowed for use in any vascular external lesions of the mucous membranes. Medicines may have a broad or relatively limited spectrum of action. There are, for example, hemostatic drugs for hemorrhoids. Forms of medicines are also different. When localizing damage in the intestinal region, for example, it is more appropriate to use hemostatic suppositories. In some other cases, it is more effective to use solutions or tablets. For example, menstrual hemostatic agents are often available in tablet form or in ampoules.
Medication"Vikasol"
This medicine is a water-soluble synthetic analogue of K-vitamin. This drug helps to stop only such bleeding, which is due to a reduced content of prothrombin. This, in turn, is provoked by a deficiency of K-vitamin. The drug "Vikasol" stimulates prothrombin synthesis by liver cells. Indications for the use of this remedy include violations of hemostasis in cirrhosis, hepatitis, renal-hepatic syndrome, obstructive jaundice. The drug is recommended for bleeding against the background of an overdose of indirect anticoagulants (drugs "Pelentan", "Neodicumarin" and others). The drug is not effective in Werlhof's disease and hemophilia. The drug has some effect in menopausal and juvenile uterine, ulcerative bleeding. The effect of the drug is noted no earlier than 12-18 hours after its administration. Like many hemostatic agents for uterine bleeding, Vikasol is available in tablet form and as a solution. Orally, the drug is recommended at 0.015 g / 2-3 r / day. Hemostatic injections "Vikasol" are prescribed intramuscularly in 1 ml of a 1% solution 1-2 r / day, in a row for no more than four days (due to the likelihood of thrombosis). Contraindications to the use of the drug include myocardial infarction (acute), thrombophlebitis, increased clotting.
Vitamin P
This remedyis a complex of tea catechins. Vitamin P slows down the activity of hyaluronidase (it dissolves the connective tissue base in the capillary wall), reducing to some extent the fragility and permeability of small-caliber vessels. At the same time, vitamin P prevents the oxidation of ascorbic acid. It also strengthens the capillary wall. The most common drug of vitamin P is the drug "Rutin". It is a water-insoluble greenish-yellow powder. The drug "Rutin" to some extent reduces the severity of hemorrhagic skin rash against the background of Werlhof's disease and capillary toxicosis. The drug is prescribed for retinal hemorrhages, measles, septic endocarditis, scarlet fever. When using vitamin P, thrombosis practically does not occur, there are no contraindications. The drug is produced in tablet form in pure form, 0.02 g each and in combination with ascorbic acid (Ascorutin agent) (0.5 g of each component). For adults, the drug is recommended at a dosage of 0.02-0.05 g / 3 r / day.
Epsilon-aminocaproic acid
This remedy is presented as a white crystalline powder. Substance has no taste and a smell, it is well soluble in water. Epsilon-aminocaproic acid has a powerful hemostatic effect (local and general), slowing down the activity of the fibrinolytic structure. Along with this, the medication reduces the tryptic activity that digestive juices exhibit. Epsilon-aminocaproic acid is prescribed for gingival, nasal,intestinal, gastric, uterine, renal bleeding of various origins, with Werlhof syndrome, hemophilia, aplastic anemia, and after curettage of the uterus, including. In stationary conditions, the drug is used after interventions on the lungs, prostate, with premature detachment of the normally located placenta. The agent is prescribed orally at 3-5 g / 3-4 r / day. It is recommended to drink the powder with sweet water. In addition, epsilon-aminocaproic acid is administered both by jet and drip into a vein, 100 ml each. The drug is successfully used for local hemostasis in case of bleeding from the nasal mucosa or tooth socket after extraction. In this case, the affected area is abundantly sprinkled with powder. Against the background of oral administration, the drug does not irritate the digestive tract. In extremely rare cases, patients may complain of nausea. After intravenous administration, the maximum effect is observed after 1-4 hours. Epsilon-aminocaproic acid has contraindications. These include, in particular, kidney failure (acute course), thrombosis.
Medical gelatin
Collagen hydrolyzate is a colorless gelatinous mass or yellowish leaves. Against the background of intravenous administration, the drug contributes to an increase in blood viscosity, platelet stickiness. This ensures a fairly rapid and pronounced hemostatic effect in cases of internal bleeding. These, among others, include both intrapleural and gastrointestinal. Lessthe effect is noted with damage to the vascular network of mucous membranes. Allergy is a side effect. The drug is mainly prescribed intravenously in a dose of 50-100 ml of a solution heated to 37 degrees. The medicine is produced in 10 ml ampoules of 10% gelatin in 5% sodium chloride.
Fibrinogen K3 or M2
This is a human blood product, I clotting factor. It is used for afibrinogemic bleeding. Enter drip intravenously (per day up to 1.8-2 grams of dry matter). Before use, the powder is directly dissolved in a physiological (sterile) solution, the temperature of which is 25-30 degrees. Infusion is performed with the obligatory presence of a filter in the system, since elements of insoluble protein can be detected in the solution. Infusion is not prescribed for myocardial infarction (acute), thrombophlebitis.
The drug "Trasilol"
This preparation is derived from the parotid glands of cattle. The drug is able to slow down the progression of intravascular microcoagulation and break down trypsin. It is prescribed for bleeding accompanying extensive tissue injuries, after septic abortion, against the background of acute leukemia (promyelocytic, for example) and other conditions. Dosage 10-20 thousand IU drip intravenously per day 1-2 times in a five percent glucose solution (or physiological). Usually the introduction of the drug is carried out in stationary conditions. The drug is also used for chronic andacute forms of pancreatitis, mumps. Among the side effects, the most common are: allergies up to anaphylactic shock, as well as phlebitis at the injection site.
Protamine Sulfate
This is a protein derivative that has the ability to form insoluble complexes with thromboplastin and heparin. The drug is prescribed for hemorrhages provoked by hyperheparinemia. It, in turn, is the result of an overdose or increased production of endogenous heparin. The drug provides a fairly quick (within 1-2 hours) stop of the blood flow. As a rule, a 1% solution is administered in a volume of 5 ml intramuscularly or intravenously. If necessary, re-infusion is carried out after 15 minutes. During therapy with protamine sulfate, control of clotting time should be ensured. The drug is available in ampoules of five milliliters of a one percent solution.
Solution "Hemophobin"
This is a relatively weak hemostatic for hemorrhoids. It is used intramuscularly, orally or topically. Dosage for oral administration 1 table. spoon 2-3 r / day. Intramuscularly, 5 ml of a 1.5% solution is prescribed. The Hemophobin medication, like many other hemostatic drugs, is available in 5 ml ampoules and 150 ml bottles.
Drug "Adrokson"
This medicine is an orange powder,tasteless and odorless. The drug is effective in capillary bleeding due to minor injuries, after tooth extraction, tonsillectomy. A 0.025% solution is used for wetting tampons and intramuscular injections repeatedly before, during and after interventions. The drug is also effective in GI bleeding. The medicine is produced in ampoules of 1 ml 0.025%.
The medicine "Etamzilat"
This drug improves platelet function, reduces capillary permeability. The drug is recommended for the treatment and prevention of vascular disorders after tooth extraction, tonsillectomy. Indications include both intestinal and pulmonary bleeding. The maximum duration of the effect is 1-2 hours when injected into a vein and 3 hours when taken orally. For prophylactic purposes, the drug is prescribed intramuscularly or orally. To eliminate bleeding, 2-4 ml is injected into a vein or muscle, then 2 ml every 4-6 hours. The medicine is produced in tablet form of 0.25 gr. and in 2 ml ampoules as a 12.5% solution.
Medicinal herbs
Healing properties of plants have been known since ancient times. Medicinal herbs in the form of extracts are present in many hemostatic medicines. Such hemostatic agents are used for heavy periods, disorders localized in other areas. A variety of tinctures, water and alcohol, tablets, drops are also produced. Specialists often use hemostatic drugs ingynecology. Especially during gestation and lactation. However, the use of hemostatic during pregnancy and during feeding must be extremely careful so as not to harm the unborn child.
Lagohilus tincture
This product contains tannins and latochiline. The tincture has a stimulating (moderate) effect on the coagulation system and a slight sedative effect. It is used as a hemostatic agent for menstruation, nosebleeds. It is recommended to take orally a teaspoon of a ten percent solution with water (for 0.25 cups) 3-4 times a day. As a side effect, a laxative effect is manifested to a moderate degree. Swabs soaked in solution can be used for hemorrhoidal or epistaxis.
Nettle leaf extract
This product contains vitamin K, ascorbic acid, tannins. An extract is recommended for intestinal, renal flows, with Werlhof's syndrome. Nettle contains many hemostatic drugs used for heavy periods and other vascular damage.
Yarrow Herb (Liquid Extract)
This solution contains resins and tannins, ascorbic acid, alkaloids. To enhance the effect, in some cases, hemostatic drugs are combined. With heavy periods, this is especially true. In such situations, yarrow herb and nettle extract are very effective.
Pepper liquid extract
It has routine,quercetin. Like some other hemostatic drugs for heavy periods, pepper extract also contains tannins. It is recommended 30-40 drops three times a day. Pepper extract is contained in the medicine "Anestezol" (candles).
Topical medicines
As a rule, such hemostatic drugs are used for cuts. They allow you to quickly and effectively eliminate violations. They can be used in emergencies. There are hotel hemostatic drugs for wounds. Next, consider some local medicines.
Hemostatic sponge
This is a human plasma preparation. The hemostatic sponge contains thromboplastin and calcium chloride. The latter has a good local effect on gingival, nasal, hemorrhoidal bleeding. A piece is sterilely separated from the sponge and applied to the damaged, previously dried area. The drug is tightly pressed with a gauze swab. A day later, the remains of the formed fibrin film are carefully removed from the edges. The remnants of the sponge dissolve on their own within 20-30 days. Unused residues from the opened sponge container can only be used after re-sterilization. The drug has no contraindications.
Thrombin
This preparation of human plasma is a fluffy white-pink mass. Being a catalyst for the transformation of fibrinogen into fibrin, the drug has a direct hemostatic effect.action. Thrombin is used only for local capillary damage of a different nature, including after tooth extraction. The bottle with the drug is sterilely opened before use, a physiological solution (10-15 ml) at room temperature is introduced into it. After thrombin dissolves, the swab is soaked with this mixture and pressed tightly against the damaged area. After the bleeding has stopped, it is carefully removed, moistened with saline to prevent re-damage.
Fibrin film
Preparation of human or animal (bovine) plasma. It contains thromboplastin. The drug has a moderate hemostatic effect. Fibrin film is used for local lesions in the mucosa. Before use, the test tube is sterilely opened, the film is removed. Then it is washed with saline or Penicillin or Rivanol. After that, the medication is applied to the damaged surface. Fibrin film may cause allergic reactions.
