Hemostatic drugs. Hemostatic drugs in gynecology

Quite often in their practice, mid-level health workers have to face bleeding of different locations. 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 nasal damage and other localization. Against the background of a number of pathologies, violations of the generalized type develop. For example, with aplastic anemia, Verlhof disease, capillarotoxicosis and others. Further we will understand, what today exist haemostatic preparations.

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 an acute internal flow occurs, hemostatic drugs are injected directly at the site of the accident or during transportation of the victim to the hospital.

Coagulation Factors

As observations show, against the backdrop 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 the 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, the blood is maintained in the liquid state.

Causes of violations

Bleeding in practice, as a rule, is caused either by a deficit of some coagulation factor, for example, in viral hepatitis, jaundice of a mechanical type, hemophilia, or a reduced content of platelets (with Verlhof's syndrome, aplastic anemia and other pathologies). Often as a trigger mechanism are the smallest numerous thromboses in the capillaries. They develop with further overexpenditure of certain clotting factors and platelets. This, in turn, leads to hemorrhagic syndrome. A similar picture is noted against a background of severe shock (cardiogenic, traumatic), poisoning, septic conditions (after criminal abortion, including), extensive operations, especially with massive blood transfusions. Previously, this pathological condition was defined as "fibrinolytic bleeding". At present, it is referred to as the syndrome of intravascular widespread microcracking.

Therapy: general information

Properly selected hemostatic agents with uterine bleeding, capillary local lesions affect the impaired primary hemostasis. In general, competent therapy involves the use of one, in rare cases, two, medicines in optimal dosages. For example, hemophilic hemorrhage uses infusion of fresh plasma or "Cryoprecipiate". And such drugs as "Vikasol" or calcium chloride, in such cases do not apply. The affected link in the hemostatic system can be determined already in accordance with the anamnestic data and the symptoms found during the examination of the patient. In this regard, before the therapy, you should identify the origin of the disorder. Nevertheless, hemostatic preparations of local action are allowed for use in any vascular external lesions of mucous membranes. Medications can have a broad or relatively limited spectrum of action. There are, for example, haemostatic drugs for hemorrhoids. Forms of medicines are also different. When localizing lesions in the intestinal region, for example, it is more appropriate to use hemostatic candles. In some other cases, solutions or tablets are more effective. For example, hemostatic agents with monthly are often issued in tablet form or in ampoules.

The medicine "Vikasol"

This medication is a water-soluble synthetic analogue of K-vitamin. This drug helps stop only such bleeding, which is due to a reduced content of prothrombin. This, in turn, was provoked by a deficiency of K-vitamin. Medication "Vikasol" stimulates prothrombin synthesis by liver cells. Indications for the use of this remedy include violations of hemostasis in cirrhosis, hepatitis, renal and hepatic syndrome, obstructive jaundice. The drug is recommended for bleeding against an overdose of anticoagulants indirect action (drugs "Pelentan", "Neodikumarin" and others). The medication is not effective in Verlhof disease and hemophilia. The drug has some effect with menopausal and juvenile uterine, ulcerous bleeding. The action of the medication is noted no earlier than 12-18 hours after its administration. Like many hemostatic agents in uterine bleeding, the drug "Vikasol" is available in tablet form and as a solution. Oral medicine is recommended at 0.015 g / 2-3 r / day. Haemostatic injections "Vikasol" appoint intramuscularly 1 ml of a 1% solution 1-2 r / day, in a row for no more than four days (due to the probability of thrombosis). Contraindications for the use of the drug include myocardial infarction (acute), thrombophlebitis, increased coagulability.

Vitamin P

This remedy is a complex of tea catechins. Vitamin P slows 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. Together with this, vitamin P inhibits the oxidation of ascorbic acid. It also has a strengthening effect on the wall of the capillary. The most common drug of vitamin P is the "Rutin" medication. It is an insoluble in water powder of a greenish-yellow color. The drug "Rutin" to some extent reduces the severity of hemorrhagic skin rash against the background of Verlhof's disease and capillarotoxicosis. The drug is prescribed for hemorrhages in the retina of the eye, measles, septic endocarditis, scarlet fever. When vitamin P is used, there is practically no thrombosis, there are no contraindications. The drug is given in tablet form in pure form at 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 smell, it is 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 manifest. Epsilon-aminocaproic acid is prescribed for gingival, nasal, intestinal, gastric, motor, renal bleeding of a different origin, with Verlhof's syndrome, hemophilia, aplastic anemia and after curettage of the uterus as well. In stationary conditions, the medication is used after interventions on the lung, prostate, with premature detachment of the normally located placenta. Assign means inwards for 3-5 g / 3-4 r / day. It is recommended to drink powder with sweet water. In addition, epsilon-aminocaproic acid is injected and struined, and drip into a vein of 100 ml. The medication is successfully used for local hemostasis with bleeding from the nasal mucosa or tooth socket after removal. In this case, the affected area falls abundantly with powder. Against the background of oral administration of the drug does not have an irritant effect on 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. Among them, in particular, include kidney failure (acute course), thrombosis.

Medical Gelatin

The hydrolyzate of collagen is a colorless gelatinous mass or yellowish leaflets. Against the background of intravenous administration of the drug helps increase blood viscosity, stickiness of platelets. Thanks to this, a fairly rapid and pronounced hemostatic effect is achieved in cases of internal bleeding. Among them, among others, include intrapleural and gastrointestinal. A smaller effect is noted when the vascular network of mucous membranes is damaged. As an adverse reaction is an allergy. The medicine is mainly prescribed by intravenous drip in a dose of 50-100 ml heated to 37 degrees solution. The drug is produced in ampoules of 10 ml of 10% gelatin in 5% sodium chloride.

Fibrinogen K3 or M2

It is a preparation of human blood, I coagulation factor. It is used for afrobrinohemicheskih bleeding. Enter drip intravenously (per day to 1.8-2 grams of dry matter). Before use, the powder is dissolved in a physiological (sterile) solution, the temperature of which is 25-30 degrees. Infusion is performed when there is a mandatory presence in the filter system, since insoluble protein elements can be detected in the solution. No infusion is prescribed for myocardial infarction (acute), thrombophlebitis.

The medicine "Trasilol"

This drug is derived from the parotid glands of cattle. The medication is able to slow the progression of intravascular microclavation and cleave trypsin. It is prescribed for bleeding accompanied by extensive tissue trauma, after septic abortion, against a background of leukemia of acute type (promyelocytic, for example) and other conditions. Dosage of 10-20 thousand units is drip intravenously per day 1-2 times on a 5% solution of glucose (or physiological). Usually, the medication is administered in a stationary setting. The medication is also used for chronic and acute forms of pancreatitis, parotitis. Among the side effects, the most common are: allergy up to anaphylactic shock, as well as phlebitis at the site of administration.

Protamine sulfate

This protein derivative, which has the ability to form with thromboplastin and heparin insoluble complexes. The drug is prescribed for hemorrhages provoked by hypergeparinemia. It, in turn, is the result of an overdose or increased production of endogenous heparin. The medication provides a sufficiently fast (for 1-2 hours) stopping the flow of blood. As a rule, a 1% solution in a volume of 5 ml is administered intramuscularly or intravenously. If necessary, re-infusion is performed after 15 minutes. During the treatment with protamine sulfate, coagulation time should be monitored. The medication is issued in ampoules of five milliliters of a 1% solution.

The solution of "Hemofobin"

This is a relatively weak hemostatic with hemorrhoids. It is used intramuscularly, inside or locally. Dosage at oral intake 1 table. Spoon 2-3 r / day. Intramuscularly administered 5 ml 1.5% solution. Medication "Hemofobin", like many other hemostatic drugs, is available in ampoules of 5 ml and bottles of 150 ml.

Medication "Adroxon"

This medication is an orange powder that does not taste or smell. The drug is effective for capillary bleeding due to minor injuries, after tooth extraction, tonsillectomy. A 0.025% solution is used to wet tampons and intramuscular injections repeatedly before, during and after the interventions. The drug is effective for LCD bleeding. The medication is issued in ampoules of 1 ml 0.025%.

The medicine "Etamsilat"

This drug improves the function of platelets, reduces capillary permeability. The medication is recommended for the treatment and prevention of vascular disorders after tooth extraction, tonsillectomy. Indications include both intestinal and pulmonary hemorrhages. The maximum duration of the effect is 1-2 hours when administered in a vein and 3 hours - when taken orally. For preventive purposes, medication is prescribed intramuscularly or orally. To eliminate bleeding in a vein or muscle inject 2-4 ml, then every 4-6 hours for 2 ml. The drug is given in tablet form according to 0.25 g. And in ampoules of 2 ml in the form of a 12.5% solution.

Medicinal herbs

Healing properties of plants are known from ancient times. Medicinal herbs in the form of extracts are present in many haemostatic medicines. Such haemostatic agents are used in case of heavy monthly, disorders, localized and in other areas. Also available are a variety of tinctures, water and alcohol, tablets, drops. Specialists often use haemostatic drugs in gynecology. Especially in the period of gestation and during lactation. However, it is necessary to apply hemostatic during pregnancy and during feeding very carefully so as not to harm the future child.

Tincture of lagohilus

This remedy contains tannins and latohilin. Tincture has a stimulating (moderate) effect on the coagulation system and a mild sedative effect. It is used as a hemostatic with monthly, nasal bleeding. It is recommended to take a ten-percent solution with water (by 0.25 cups) a day 3-4 times a day using a teaspoon. As a side effect, a moderate effect is shown. Moistened tampons can be used for hemorrhoidal or nasal bleeding.

Extract of nettle leaves

This product contains vitamin K, ascorbic acid, tannins. Recommended extract for intestinal, renal currents, with Verlhof syndrome. Nettle contains many hemostatic drugs, with abundant period and other vascular lesions used.

Yarrow herb (liquid extract)

In this solution, there are gums and tannins, ascorbic acid, alkaloids. To increase the effect in some cases, combining hemostatic drugs. With abundant periods this is especially true. In such situations, the yarrow herb and nettle extract are very effective.

Liquid extract of pepper

It has rutin, quercetin. Like some other haemostatic drugs with abundant periods, the extract of pepper also contains tannins. It is recommended to 30-40 drops three times a day. Pepper extract is contained in the medicine "Anestezol" (candles).

Local 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 emergency cases. There are hotel hemostatic drugs in wounds. Next, consider some of the local medicines.

Hemostatic sponge

This is a preparation of human plasma. Thromboplastin and calcium chloride are present in the hemostatic sponge . The latter has a good local effect on gingival, nasal, hemorrhoidal bleeding. From the sponge a sterile piece is separated and applied to the damaged, pre-dried area. The drug is tightly pressed gauze swab. After a day, the remains of the formed fibrin film from the edges are carefully removed. The remains of the sponge dissolve independently for 20-30 days. Unused residues from the opened jar with a sponge can be used only after repeated sterilization. There are no contraindications to the drug.

Thrombin

This drug of human plasma is a loose white-pink mass. Represents a catalyst for the reaction of the transformation of fibrinogen into fibrin, the drug has a direct hemostatic effect. Thrombin is used only for local capillary lesions of a different origin, after tooth extraction, including. The vial with the preparation is sterilely opened before use, physiological solution (10-15 ml) of room temperature is introduced into it. After thrombin has dissolved, the tampon is soaked with this mixture and is pressed firmly against the damaged area. After stopping bleeding, carefully remove it, moistening with saline solution to avoid repeated damage.

Fibrin film

A preparation of human or animal (RNC) plasma. It contains thromboplastin. The drug has a moderate hemostatic effect. Fibrin film is used for local lesions in the mucosa. Before use, the tube is sterilely opened and the film is removed. Then it is washed with saline or with "Penicillin" or "Rivanol". After that, the medicine is applied to the damaged surface. When using fibrin film, an allergy may develop.