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 gingival and other. Today, various hemostatic agents are used: with uterine bleeding, capillary lesions of 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 disease, capillarotoxicosis and others. Next, we will understand 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, when there is an acute internal course, hemostatic drugs are injected directly at the scene of the accident or in the process of transporting the victim to the hospital.
Coagulation factors
As observations show, against the background of internal pathologies, bleeding is caused mainly by violations in the coagulation system. The processes in it are 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 (anticoagulant) system, blood is maintained in a liquid state.
Causes of Violations
Bleeding in practice, as a rule, is caused either by a deficiency of some coagulation factor, for example, with viral hepatitis, mechanical jaundice, hemophilia, or a low platelet count (with Verlhof syndrome, against aplastic anemia, and other pathologies). Often, the smallest numerous thromboses in the capillaries act as a trigger. They develop with a further overspending of certain coagulation factors and platelets. This, in turn, leads to hemorrhagic syndrome. A similar picture is observed against the background of a shock of a severe nature (cardiogenic, traumatic), poisoning, septic conditions (including after a criminal abortion), extensive operations, especially with massive blood transfusions. Previously, this pathological condition was defined as "fibrinlitic bleeding." Currently, it is called intravascular disseminated microcoagulation syndrome.
Therapy: General Information
Properly selected hemostatic agents for uterine bleeding, local capillary lesions affect 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, with hemophilic bleeding, an infusion of fresh plasma or the cryoprecipitate is used. And drugs like Vikasol or calcium chloride are not used in such cases. The affected link in the hemostatic system can be determined in accordance with anamnestic data and symptoms detected during the examination of the patient. In this regard, before conducting therapy, the genesis of the disorder should be identified. Nevertheless, hemostatic topical preparations are allowed for use in any vascular external mucosal lesions. Medicines may have a broad or relatively limited spectrum of action. There are, for example, hemostatic drugs for hemorrhoids. The forms of medicines are also different. When localizing damage in the intestinal region, for example, it is more advisable to use hemostatic suppositories. In some other cases, it is more effective to use solutions or tablets. For example, hemostatic agents for menstruation are often available in tablet form or in ampoules.
The medicine "Vikasol"
This medication is a water-soluble synthetic analogue of K-vitamin. This drug helps to stop only such bleeding, which is caused by 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 use of this drug include hemostasis disorders with cirrhosis, hepatitis, renal-hepatic syndrome, obstructive jaundice. The drug is recommended for bleeding on the background of an overdose of indirect anticoagulants (Pelentan, Neodicumarin and others). The medication does not show effectiveness in Verlhof disease and hemophilia. The drug has some effect with menopause 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, the drug "Vikasol" is available in tablet form and in the form of a solution. Orally, the drug is recommended at 0.015 g / 2-3 r / day. Hemostatic injections "Vikasol" is prescribed intramuscularly in 1 ml of a 1% solution of 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 medication include myocardial infarction (acute), thrombophlebitis, and increased coagulability.
Vitamin P
This tool is 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. Along with this, vitamin P prevents the oxidation of ascorbic acid. It also has a firming effect on the capillary wall. The most common vitamin P drug is Rutin. It is a water-insoluble greenish-yellow powder. The medicine "Rutin" to some extent reduces the severity of hemorrhagic skin rash on the background of Verlhof disease and capillarotoxicosis. The drug is prescribed for hemorrhages in the retina, measles, septic endocarditis, scarlet fever. When applying vitamin P, thrombosis practically does not occur, there are no contraindications. The medicine is produced in tablet form in a pure form of 0.02 g and in combination with ascorbic acid (Ascorutin) (0.5 g of each component). For adults, the drug is recommended in a dosage of 0.02-0.05 g / 3 r / day.
Epsilon-aminocaproic acid
This agent is presented as a white crystalline powder. The substance has no taste and odor, is readily soluble in water. Epsilon-aminocaproic acid has a powerful hemostatic effect (local and general), slowing down the activity of the fibrinolytic structure. At the same time, the medication reduces the tryptic activity that digestive juices exhibit. Epsilon-aminocaproic acid is prescribed for gingival, nasal, intestinal, gastric, skeletal, renal hemorrhages of various origins, with Verlhof syndrome, hemophilia, aplastic anemia, and after curettage including. In stationary conditions, the medication is used after interventions in the area of the lungs, prostate, with premature detachment of the normal placenta. The drug is administered orally at 3-5 g / 3-4 p / day. Drinking powder is recommended with sweet water. In addition, epsilon-aminocaproic acid is administered both in a jet and drip manner into a vein of 100 ml. The medication has been successfully used for local hemostasis in case of bleeding from the nasal mucosa or tooth hole after removal. In this case, the affected area is abundantly dusted with powder. Against the background of oral administration, the medication 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, in particular, include renal failure (acute course), thrombosis.
Medical gelatin
The collagen hydrolyzate is a colorless gelatinous mass or yellowish leaves. Against the background of intravenous administration, the medication increases the viscosity of the blood, the stickiness of the platelets. Due to this, a sufficiently rapid and pronounced hemostatic effect in cases of internal bleeding is provided. Among them, among others, include both intrapleural and gastrointestinal. A lesser effect is noted with damage to the vascular network of the mucous membranes. An allergy is an adverse reaction. The medicine is mainly prescribed drip intravenously in a dose of 50-100 ml of a solution warmed up to 37 degrees. A medicine is produced in ampoules of 10 ml of ten percent gelatin in five percent sodium chloride.
Fibrinogen K3 or M2
This is a drug of human blood, I coagulation factor. It is used for afibrinogenemic bleeding. Enter drip intravenously (per day up to 1.8-2 g. Dry matter). Before use, the powder directly dissolves in a physiological (sterile) solution, the temperature of which is 25-30 degrees. The infusion is carried out with the obligatory presence of a filter in the system, since insoluble protein elements can be detected in the solution. An infusion is not prescribed for myocardial infarction (acute), thrombophlebitis.
Medicine "Trasilol"
This drug is derived from the parotid glands of cattle. The medication is able to slow the progression of intravascular microcoagulation and break down trypsin. It is prescribed for bleeding accompanying extensive tissue injuries, after septic abortions, against the background of acute leukemia (promyelocytic, for example) and other conditions. Dosage of 10-20 thousand units, drip intravenously per day, 1-2 times in a five percent glucose solution (or physiological). Typically, the introduction of the drug is carried out in a hospital. The medication is also used for chronic and acute 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
It 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 medication provides a fairly quick (within 1-2 hours) stop the flow of blood. As a rule, a one percent solution is introduced in a volume of 5 ml intramuscularly or intravenously. If necessary, repeated infusion is carried out after 15 minutes. During therapy with protamine sulfate , coagulation time control should be provided. The medication is available in ampoules of five milliliters of a one percent solution.
Hemophobin Solution
This is a relatively weak hemostatic with hemorrhoids. It is used intramuscularly, inside or topically. Dosage for oral administration of 1 table. spoon 2-3 r / day. Intramuscularly, 5 ml of a 1.5% solution is prescribed. The Hemofobin medication, like many other hemostatic drugs, is available in 5 ml ampoules and 150 ml vials.
Medicine "Adrokson"
This medication is an orange powder that has no taste or smell. The medicine is effective for capillary bleeding due to minor injuries, after tooth extraction, tonsillectomy. A 0.025% solution is used to wet the swabs and intramuscular injections repeatedly before, during and after the intervention. The drug is effective in LCD bleeding. The drug is produced in ampoules of 1 ml 0.025%.
Medicine "Etamsilat"
This drug helps to improve platelet function, reduces capillary permeability. The medication is recommended for the treatment and prevention of vascular disorders after tooth extraction, tonsillectomy. Indications include 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 preventive purposes, the medication is prescribed intramuscularly or orally. To eliminate bleeding, 2-4 ml are injected into a vein or muscle, then 2 ml every 4-6 hours. The medicine is produced in tablet form at 0.25 g. and in 2 ml ampoules in the form of a 12.5% solution.
Medicinal herbs
The 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 in case of heavy periods, disorders, localized in other areas. A variety of tinctures, water and alcohol, tablets, drops are also available. Specialists often use hemostatic drugs in gynecology. Especially during gestation and during lactation. However, it is necessary to use hemostatic during pregnancy and during feeding with extreme caution so as not to harm the unborn baby.
Tincture of lagohilus
This product contains tannins and latochilin. Tincture has a stimulating (moderate) effect on the coagulation system and a slight sedative effect. It is used as a hemostatic in menstruation, nosebleeds. It is recommended to take by mouth a teaspoon of a ten percent solution of water (0.25 cups) per day 3-4 times. As a side effect, a laxative effect to a moderate degree is manifested. Tampons moistened with solution can be used for hemorrhoidal or nosebleeds.
Nettle leaf extract
This product contains vitamin K, ascorbic acid, tannins. Recommended extract for intestinal, renal, in Verlhof syndrome. Nettle contains many hemostatic drugs, with abundant periods and other vascular lesions used.
Yarrow herb (liquid extract)
Resins and tannins, ascorbic acid, alkaloids are present in this solution. To enhance the effect, in some cases hemostatic preparations are combined. With abundant periods, this is especially true. In such situations, yarrow herb and nettle extract are very effective.
Liquid pepper extract
It contains rutin, quercetin. Like some other hemostatic drugs for heavy periods, pepper extract also contains tannins. It is recommended for 30-40 drops three times a day. Pepper extract is contained in the medicine "Anestezol" (candles).
Local medicine
As a rule, such hemostatic drugs are used for cuts. They allow you to quickly and effectively eliminate violations. They can be used in emergency cases. There are separate hemostatic drugs for wounds. Next, we will consider some local medicines.
Hemostatic sponge
This is a human plasma drug. Thromboplastin and calcium chloride are present in the hemostatic sponge . The latter has a good local effect with 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. After a day, the remains of the formed fibrin film from the edges are carefully removed. The remnants of the sponge dissolve on their own for 20-30 days. Unused residues from an opened vessel with a sponge can be used only after repeated sterilization. There are no contraindications to the drug.
Thrombin
This preparation of human plasma is a loose pink and white mass. , . , . , (10-15 ) . , . , .
The preparation of human or animal plasma (cattle). It contains thromboplastin. The drug has a moderate hemostatic effect. The fibrin film is used for local lesions in the mucosa. Before use, the tube is sterile opened, the film is removed. Then it is washed with saline or Penicillin or Rivanol. After this, the medication is applied to the damaged surface. When using a fibrin film, allergies can develop.