A comparison guide for HEMOSTATIC AGENTS used in Tactical Medicine
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 this 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 products 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.
PRODUCT COMPARISONS:
COMBAT GAUZE
Combat Gauze® is a fast-acting wound care dressing designed to stop arterial and venous bleeding within seconds. This hemostatic dressing combines surgical gauze with a proprietary inorganic material.
Combat Gauze® promotes clotting within minutes, allowing responders to efficiently control bleeding.
It employs the same placement technique as standard gauze, making it intuitive for medical personnel.
The vacuum-sealed, compact packaging includes eight tear points for quicker application.
QuikClot Combat Gauze produces no heat during use and has a long shelf life of five years and features an X-ray detectable strip for easy identification.
The Committee on Tactical Combat Casualty Care has endorsed Combat Gauze™ as a first-line hemostatic product
CELOX GAUZE
The US Committee on Tactical Combat Casualty Care (CoTCCC) recommends Celox Gauze, and it is widely used by NATO forces and first responder units worldwide. The Celox granules contain activated chitosan material, which effectively clots blood upon direct contact with the gauze. Notably, Celox Gauze has demonstrated improved survival rates in combat settings, outperforming other hemostatic agents tested.
CELOX GRANLES
Celox Granules are large flaky granules contained in sterile pouches that are small, flat, lightweight, and easy to store and carry. These granules are designed for rapid hemostatic control, effectively stopping severe bleeding.
Celox Granules can be used in conjunction with gauze and wound packing. A good option if hemostatic gauze is not available due to cost. Useful for smaller injuries with well-defined wound channels.
Active ingredient is chitosan, a mucoadhesive which functions independent of coagulation cascade and does not cause reactions in persons allergic to shellfish.
CELOX RAPID
Celox RAPID Gauze is a remarkable hemostatic agent designed specifically to halt external bleeding from gunshot injuries, stabs, blast wounds, and other severe bleeding incidents. What sets Celox RAPID apart from its competitors is its incredible speed, significantly reducing the treatment time required to apply pressure and stop bleeding in cases of severe arterial injuries.
In critical situations where every second counts, this gauze acts swiftly, requiring just 60 seconds of compression to achieve its life-saving effect. By combining proven haemostat technology with rapid packing capabilities, Celox RAPID ensures that casualties have a better chance of survival in emergencies or hostile environments.
Independent testing has demonstrated its efficacy in reducing blood loss compared to other hemostatic agents,, making it a reliable choice for first responders, military personnel, and emergency medical services.
Celox Rapid Ribbon
Celox A Granules Applicator
ChitoGauze - PRO
ChitoGauze is made of a polyester/rayon blend non-woven medical gauze that is coated with chitosan. The Chitosan enhances the ability of the medical gauze to control bleeding.
ChitoGauze offers antibacterial properties against a wide range of gram-positive and gram-negative organisms, including methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus faecalis, and Acinetobacter baumannii.
ChitoGauzeXR - PRO
ChitoGauzeXR2 - PRO
ChitoGauze XR2 Pro builds upon the success of its predecessor, incorporating improvements in design and functionality.
XGAUZE
When XGAUZE comes into contact with blood or exudate, its impregnated mini sponges expand up to 10 times their original size. This expansion applies 360° pressure on the wound, rapidly controlling hemorrhage.
The result? Faster and more efficient bleeding control compared to standard gauze dressings. Currently fielded by the US Military, XGAUZE has proven to be an essential asset in medical kits, simplifying wound packing and reducing dependence on technique. Its sterile, x-ray detectable design ensures reliability, making it a vital tool for emergency responders and healthcare professionals
One bandage is equivalent to the packing and absorption of 3 rolls of standard gauze.
XSTAT Device (12 & 30)
Each sponge contains an x-ray detectable marker to confirm complete surgical removal. XSTAT 12 is standard issue for SOCOM IFAKs, the CASEVAC program, and Medic/Corpsman Kits.
The XSTAT 30 is a first-in-kind hemostatic device for the treatment of gunshot and shrapnel wounds. It works by injecting small, rapidly expanding sponges into a wound cavity using a similar syringe-like applicator. These sponges expand to control hemorrhage immediately without manual compression.
Developed in collaboration with the US Military, the XSTAT 30 has been proven effective in stopping bleeding from penetrating wounds. Additionally, the XSTAT 30 P30 version encloses mini sponges in three porous pouches, making sponge removal faster and easier. It also has less packaging and a smaller cube space than the XSTAT 30 Generation.
Both XSTAT 12 and XSTAT 30 serve as critical tools in emergency situations, providing rapid and efficient bleeding control until surgical care can be acquired.
Recommended by CoTCCC as a choice for junctional wound not amenable to tourniquet use.
NuStat Tactical
This unique mechanism ensures rapid hemostasis, making it an essential tool for emergency responders, military personnel, and healthcare professionals. NuStat® is indicated for temporary bleeding control in minor cuts, lacerations, punctures, abrasions, and incisions.
NuStat® provides reliable hemorrhage management in critical situations. Independent studies have demonstrated its efficacy, showing trends toward superiority over other hemostatic products.
WoundClot™
When WoundClot™ comes into contact with blood, it undergoes a remarkable transformation: it converts from a dry, flexible gauze into a thick, tenacious, expanding gel matrix. This gel adheres to wound surfaces, rapidly achieving stable hemostasis through multiple mechanisms of action.
The 3D gel matrix absorbs up to 2,500% of its weight in blood and remains actively absorbent for up to 24 hours. By concentrating platelets, red blood cells, and clotting factors, WoundClot™ creates an environment conducive to clotting. The pliant 3D gel matrix adheres to surrounding tissues within the wound, resisting dislodgment even during patient movement or high-pressure bleeding.
WoundClot™’s advanced functional molecular groups stimulate the coagulation process by converting inactive clotting factors (such as Plasma Thromboplastin Antecedent or PTA and Hageman factors) into their active forms (XIa and XIIa).
WoundClot™ is value-priced, creates a stable clot, and does not lead to rebleeding.
This is by no means an all-inclusive list, we will periodically update this page with new products and information as they become available.
We may not have all these products listed on the website, but can obtain them if your unit or department requires them.
As always, feel free to reach out to us should you have any questions.
In the meantime, feel free to visit our outstanding selection of massive hemorrhage control products
