Topical hemostatic agents in first aid: current status of the issue and prospects for use

Background . Massive hemorrhage remains a leading cause of preventable death in severe trauma. In first aid, early hemorrhage control is critical, especially in anatomically complex areas where tourniquets cannot be applied. Topical hemostatic agents (THAs) are considered an important component of extended first aid. Objective . To analyze the current state of THAs, their mechanisms of action, efficacy, safety, and evidence base limitations. Materials and methods . A narrative review was performed. Original studies, systematic reviews, clinical guidelines, and regulatory documents on zeolite-, kaolin-, and chitosan-based THAs were analyzed. Results. Mechanisms of zeolite, kaolin, chitosan, and auxiliary components (calcium, carboxymethyl cellulose, aminocaproic acid) are reviewed. Zeolite agents are inferior in safety due to exothermic reaction. Kaolin activates factor XII, contains no animal components, and allows prolonged presence in the wound. Chitosan has multiple mechanisms but carries allergy risks and composition variability. Evidence limitations include few direct comparative studies, heterogeneity, potential author affiliation bias, lack of coagulopathy data, unresolved long-term safety, and no standardized efficacy assessment. Conclusion . Kaolin-based THAs occupy a balanced position in terms of efficacy, safety, and composition reproducibility; however, their advantage over chitosan is not absolute. The choice should be determined by the clinical situation, dosage form, availability, and user experience. Independent multicenter randomized trials with uniform endpoints and inclusion of coagulopathy patients are needed.