Hemostasis

Hemostasis is the medical term used to describe the process of stopping bleeding from injured blood vessels. Hemostasis is also considered to be one of the first steps of wound healing. Uncontrolled bleeding can lead to serious health problems.

Hemostasis starts naturally with our body’s normal healing process, but sometimes additional help is needed. Initially, vasoconstriction by the injured vessels, the formation of a natural platelet plug, and then blood coagulation are sufficient to stop minor bleeding. However, additional assistance such as local pressure applied to the wound in the form of a bandage or tourniquet is sometimes necessary. In some trauma cases urgent surgery is necessary and may be life saving in an attempt to identify and control the source of bleeding.

The treatment to control shock caused by bleeding has included intravenous saline initially before plasma or blood could be transfused. But rapid infusion of intravenous saline without replacing the necessary coagulation factors could potentiate hemorrhage because that process dilutes clotting factors.

Battlefield-tested TXA

Fortunately, there is now a battlefield-tested drug that has been shown to save lives if given within three hours of injury. In an impressive trial, a drug called Tranexamic acid/TXA was used in a large study of 20,000 bleeding patients in 40 different countries in 2010. The study was so impressive and favorable, the British and U.S. armies have now adopted it. The drug is thought to block plasmin, an enzyme that dissolves clots. The U.S. Army became interested in TXA when American soldiers were treated with it successfully in British hospitals. Severely wounded patients who received the drug survived twice as often as those who did not receive TXA.

In another large study of almost 20,000 women, TXA was found to be beneficial in stopping postpartum bleeding if used early enough. This study included 193 hospitals in 23 different countries. Postpartum hemorrhage is the leading cause of maternal death worldwide. It is estimated that at least 100,000 such deaths occur yearly and most of these are in low- to mid-income countries. The first successful transfusion of human blood to treat postpartum hemorrhage occurred in 1818.  The World Health Organization now recommends TXA for use in postpartum hemorrhage.

Not a New Drug

TXA is used in emergency cases as an IV infusion, but it is also available in oral form for excessive menstrual bleeding, and in the U.S. it is known as Lysteda.  Intravenous TXA is not often used in the U.S., but it has been approved by the FDA for some specific surgical procedures. If used more often, it could possibly save as many as 4,000 trauma patients annually in the U.S. This is not a new drug. It was invented in 1962 in Japan specifically for the treatment of postpartum hemorrhage, but for some reason it was not championed by drug companies. It is inexpensive to produce therefore profits would not be significant.

The average blood volume of an adult is about five liters/quarts. A unit of blood has a volume of around 450 to 525 milliliters, or about one pint, and 36,000 units of blood are needed daily in the U.S.  Spider webs were used by the Romans and Greeks to stop bleeding in their soldiers. Also, spider webs have antifungal and antibacterial properties that are helpful in treating a wound. Salt pork has been used at least since the early 1800s to treat nosebleeds. An interesting article appeared in 2011 in a medical journal giving credit to its use in stopping a near fatal nosebleed in a child when other methods had failed.

Poor George Washington!

Years ago, bloodletting, or the removal of blood, was thought to be helpful in reducing inflammation and for treating other forms of illness. George Washington died in December of 1799. He had complained of a severe sore throat, and as part of his treatment, 80 ounces, or approximately 40% of his blood volume, was removed over a 12-hour time period.  Losing more than 40% of the blood volume is defined as a class 4 hemorrhage, and this is often fatal unless blood replacement through transfusion is available.


Dr. David Keisler was an Army brat who lived all over the USA and North Africa. A graduate of the Citadel and the Medical University of South Carolina, he trained in the U.S. Army where he was a GI fellow and then staff physician in San Francisco at the Letterman Army Medical Center. He is board certified in internal medicine and gastroenterology and is a partner with Aiken Internal Medicine. An Aiken resident since 1983, he and his wife Jane have two daughters and ve grandchildren nearby.