Hemostatic agents.

emostasis is defined as “the stoppage of bleeding, hemorrhage, or blood flow through a blood vessel or body part.” Hemostatic agents improve hemostasis by improving primary hemostasis, stimulating fibrin formation, or inhibiting fibrinolysis. 1 Although transfusion of platelets (PLTs) and hemostatic factors are mainstays of therapy, pharmacologic agents are important adjuncts as blood products become increasingly in short supply, and alternative therapies need to be considered. Multiple pharmacologic approaches with hemostatic agents to treat or prevent bleeding are based on either preventing or reversing the defects associated with preexisting or acquired coagulopathy, with patients often presenting with multiple problems. The increasing use of drugs in cardiovascular medicine that inhibit PLT function or thrombin including clopidogrel, low-molecular-weight heparins, fondaparinux, and melagatran present the clinician with agents that may not be readily reversible with standard therapies. 2 Therapeutic approaches for pharmacologic management with hemostatic agents are listed in Table 1. Newer therapies including the potential use of recombinant activated factor (F) VIIa as a therapy for refractory bleeding will also be considered. H APROTININ