A comparison guide for hemostatic agents used in tactical medicine and bleeding control.

The hemostatic product range is, like tourniquets, always a source of debate among members of the community   Often times, information is propagated based on anecdotal evidence, favoritism, brand loyalty, or "I only use what the military uses".  Sometimes the studies and actual evidence get brushed aside and this tends to confuse the newer medic or citizen who is just learning about these products.

The following chart features what we feel is a good summary of each product based on their merits. They are listed in no particular order and we do not favor one over the other.  Hopefully this information will allow you to make a more informed purchasing decision.

First, how do these products work?.
Hemostatic products work by delivering a specialized agent directly to the point of the injury (injured vessel), in conjunction with good packing technique, and subsequent direct pressure.  There are two main active ingredients in these products, and each product brand incorporates some proprietary materials in order to enhance their product.   The two main ingredients found in these products are:

KAOLIN:  This is an inorganic mineral that works on contact with the blood to immediately initiate the clotting process by activating factor XII of the body's Coagulation Cascade.  This reaction leads to the transformation of factor XII to its activated form XIIa, which instigates the rest of the cascade and brings about clotting much faster than normal.  Kaolin is non-allergenic and purports a low-to-no-risk of adverse reactions.  Kaolin is also NON-THERMOGENIC, it will not cause exothermic reactions like the old Quick-Clot products

CHITOSAN:  This is a linear polysaccharide material derived from Chitin which is found naturally in crustacean exoskeleton or shell. There have been no known or suspected allergic reactions as a result of using the Chitosan based products produced by Celox since its launch in 2006. The chitosan has been extensively tested on individuals with suspected and confirmed shellfish allergy, none of the test subjects demonstrated any dermal sensitivity when tested against the chitosan material.  Chitosan does not work on the body's Coagulation Cascade, it works when the granules swell, gel, and stick together forming a gelatinous plug with the blood, again, without generating any heat.

Do these products work better than standard gauze?
Yes and no.  We say that because numerous studies have shown that you WILL achieve hemostasis regardless of what product you use, even if you use regular gauze.  If you deliver high quality, continuous pressure to the wound site, blood flow will very likely be stopped.  Sure, it will take a while longer with regular gauze, but the success rates are very similar.  Where these products stand out versus regular gauze is the fact that hemostasis is achieved much faster.  These products, on average, and again, with the proper technique, may stop blood flow in as little as 3 minutes.  Some products, such as Celox Rapid, are purported to stop bleeding in as little as 90 seconds.  With standard gauze, it could take 10 minutes or more to fully stop blood flow!

What about interactions with anticoagulants or on patients with bleeding disorders?   Will these work if the patient is hypothermic?

The jury is still out on this one as there have been no widespread testing of these issues.  Yes, individual manufacturers have done their own testing, but there is no consensus in the community about this.  We say that it makes sense to hypothesize that if a Kaolin based product "may" not work on a patient who is on anticoagulants such as Warfarin as the mechanism of action of the product and the drug oppose each other.  However, we point to the lack of scientific evidence to support this.   We know Kaolin based products are extensively used in civilian EMS and no doubt used with great success on patients who undoubtedly have been on anticoagulants.  We base that on the overwhelming number of people on anticoagulants in the USA, if these products would continuously fail, then the issue would have been raised by now.

Celox claims they have tested their products (in a lab setting) to work in the presence of Warfarin and Heparin, and in blood as cool as 65 degrees Fahrenheit.

Why is Combat Gauze "preferred" by the DOD over all the other products?

No one can really say for sure!  Perhaps it is because the ISR safety model testing, perhaps because of the FDA approval, perhaps because it is made in the USA (Celox products are from the U.K.), perhaps because Z-Medica was first to the market, perhaps because there are more good studies focusing on this product over others, perhaps because of it would cost too much money to make changes.  We are sure, however, that it does not have to do with this product outperforming other gauze.