How hemostatic agents interact with the coagulation cascade.

Hemostasis is a critical component of the preservation of hemodynamic stability and operative visibility during surgery. Initially, hemostasis is achieved via the careful application of direct pressure to allow time for the coagulation cascade to create a fibrin and platelet plug. Other first-line methods of hemostasis in surgery include repair or ligation of the bleeding vessel with sutures, clips, or staples and coagulation of the bleeding site with a thermal energy-based device. When these methods are insufficient to provide adequate hemostasis, topical hemostatic agents can be used to augment the creation of a clot during surgery. A basic understanding of how and where these products interact with the coagulation cascade is essential to achieving optimal hemostasis outcomes.