Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery

Table 1

Overview of hemostasis.

Stages of hemostasis	Physiology	Monitoring
Primary hemostasis
Formation of the platelet plug	Platelets first adhere to the exposed collagen and von Willebrand’s factor on the subendothelium. Then, circulating stimuli activate the platelets, causing shape changes in the platelets [2]. Upon activation, platelet receptors get transferred to the surface, allowing for platelet aggregation. Platelets then release granules that stimulate further platelet aggregation and vasoconstriction [2, 3].	BT, PFA-100 analysis
Secondary hemostasis
Intrinsic pathway	Plasma proteins get activated in contact with negatively charged surfaces, leading to activation of factor XII and other clotting factors, ultimately leading to the final common pathway and formation of the fibrin clot [4].	aPTT
Extrinsic pathway	Damaged endothelium exposes tissue factor, activating the extrinsic pathway, leading to thrombin production, and activation of other clotting factors, ultimately leading to the final common pathway and formation of the fibrin clot [2, 4].	PT
Final common pathway	Both pathways lead to activation of factor X, which converts prothrombin into thrombin. Thrombin leads to formation of the insoluble fibrin clot, by converting fibrinogen into fibrin [5]. The clot is then stabilized by factor XIII [6].

Abbreviations: ADP: adenosine diphosphate, aPTT: activated partial thromboplastin time, BT: bleeding time, PFA-100 analysis: platelet function analysis, PT: prothrombin time, and TX_A2: thromboxane A₂.