Hemostatic agents

Hemostatic agents are drugs that promote hemostasis in excessive bleeding. According to the place where they interfere with the process of hemostasis, we divide them into:
 * vasoconstrictive,
 * antiplatelet (platelet aggregation inhibitors),
 * anticoagulants,
 * fibrinolytic (thrombolytic).

Vasoconstrictive phase
We use vasopressin (ADH) derivatives and α-mimetics to artificially constrict the vessel and reduce its flow (or to completely stop blood flow).

Platelet phase
We use etamsylate to facilitate the adhesion and formation of the primary plug.

For local effect
Clotting sponge contains fibrinogen and thrombin on the surface. After activation by endogenous coagulation factors a fibrin network is formed and sponge undergoes complete degeneration.

Coagulation factors
Most often as a substitution for genetic diseases - Hemophilia A - factor VIII, Hemophilia B - factor IX. Both can be replaced with fresh plasma or factor concentrates.

K-dependent factors II, VII, IX, X are used in case of overdose by oral anticoagulants ( Warfarin ), liver diseases, broad-spectrum ATB treatment. The so-called PIVKA (= proteins induced in vitamin K absence) is created.

Vitamin K
For more information see Vitamin K

It occurs naturally in plants, in the human body it is formed by saprophytic bacteria in the intestine. K-dependent coagulation factors - II, VII, IX, X.

Indication:
 * prevention or treatment of bleeding,
 * prevention of neonatal hemorrhage,
 * excessive use of oral anticoagulants,
 * sprue, celiac disease, steatorrhea, absence of bile in the duodenum (obstructive ikterus/jaundice).

Protamin sulfate
Protein, antagonista heparinu (tvoří s heparinem irreverzibilní komplexy). Podává se podle odhadu zbytkového heparinu v těle, protože ve vyšších dávkách působí antikoagulačně.

Protein, heparin antagonist (forms irreversible complexes with heparin). Its dose depends on residual heparin level in the body because protamin sulfate has an anticoagulant effect at higher doses.

Phases of fibrinolysis
Antifibrinolytics work as:
 * Inhibitiors of plasminogen activators - k. tranexamic, k. aminocaproic acid
 * direct inhibitiors of plasmin – aprotinin.

Related articles

 * Hemostasis
 * Coagulopathy