Classifying the hemostatic armamentarium of the surgeon

Hemorrhage can result in an increased mortality and morbidity. There are a variety of options to assist the surgeon in achieving hemostasis.  Modalities that result, or assist, in hemostasis were included under the term Hemostatic Modalities. Due to the variety of hemostatic modalities available, choosing the correct modality tailored for each situation and patient can be confusing. The aim was to classify and organize the different hemostatic modalities in the armamentarium available to the surgeon. Hemostatic modalities can be classified into systemic and local modalities. Systemic hemostatic modalities include blood component therapy and anticoagulant antidotes. Local hemostatic modalities are subdivided into vasoconstrictors, electrical devices, mechanical modalities, endovascular modalities and topical hemostatic agents. Topical hemostatic agents can be further subclassified into agents that function with an intact or dysfunctional patient coagulation system, i.e. “independent of the coagulation system”, and those that only function with an intact patient coagulation system, i.e. “dependent on the coagulation system”. Classifying hemostatic modalities allows for a more informed decision and a structured approach when choosing the appropriate modality. The different classes, as well as within the classes, are by no means isolated and can be used concurrently, depending on the situation, resulting in a synergistic effect for hemostasis.