Jornal de Coluna e Neurocirurgia

20 Years of Floseal Hemostatic Agent Use in Neurology and Spinal Surgery

Nitin Khanna, Manuel G Ramirez and Mark P Connolly

Studies have repeatedly demonstrated the importance of hemostasis in surgery which is essential for promoting positive outcomes and conserving healthcare resources. The need to minimize blood loss is also necessary for achieving good visibility of the operative site and preventing adverse physiological events associated with blood loss. To improve surgical outcomes hemostatic agents, including surgical sealants, have been used to achieve hemostasis in a wide range of specialties including orthopedics, traumatology, urology, neurosurgery, otorhinolaryngology, and gynecology.  One of the early commercial products FloSeal for managing hemostasis overcame the limitations of earlier topical hemostatic agents, namely variable efficacy and lack of efficacy in heparinized patients, by combing the use of gelatin-based hemostatic agents (passive hemostasis) with the application of topical thrombin (active hemostasis). In this review we describe the range of prospective randomized clinical studies in spine, and neurological surgery demonstrating the superiority of FloSeal in achieving hemostasis more rapidly and with a higher success rate than other hemostatic agents. We also provide an overview of investigations demonstrating the economic benefits of reduced blood loss both by preventing the need for transfusions and future healthcare resources. In light of the 20 years of clinical use associated with FloSeal, this review provides both historical perspective and context to the role of this product for achieving hemostasis and improving clinical outcomes.