How to control hemorrhage (excessive bleeding)?

From the Guidelines

To stop a hemorrhage, apply firm, direct pressure to the bleeding site using a clean cloth, gauze pad, or your hand if nothing else is available, as recommended by the most recent guidelines 1. This approach is supported by the 2024 American Heart Association and American Red Cross guidelines for first aid, which emphasize the importance of direct manual pressure in controlling bleeding 1.

Key Steps to Control Hemorrhage

• Maintain continuous pressure for at least 15 minutes without lifting to check the wound, as this can disrupt clot formation.
• If blood soaks through the material, add another layer on top without removing the first.
• For limb injuries, elevate the affected area above heart level while maintaining pressure.
• For severe bleeding, consider using a commercial tourniquet for life-threatening limb hemorrhage, placing it 2-3 inches above the wound and tightening until bleeding stops, as suggested by the guidelines 1.

Additional Considerations

• The use of hemostatic dressings, pressure dressings, mechanical pressure devices, and tourniquets may augment the effectiveness of direct manual pressure or avoid the need for ongoing direct manual pressure 1.
• In cases of massive hemorrhage, fluid resuscitation with warmed blood and blood components, as well as the administration of antifibrinolytic agents such as tranexamic acid, may be necessary, as recommended by the European guideline on management of major bleeding and coagulopathy following trauma 1.

Importance of Prompt Action

Prompt and effective control of hemorrhage is critical to prevent morbidity, mortality, and to improve quality of life, as emphasized by the guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Methods to Stop a Hemorrhage

• Apply direct pressure to the wound to control bleeding, as it is the most effective "medical" intervention for initial hemorrhage control 2
• Use pressure dressings, such as circumferential compressive bandages, to generate sufficient pressure to abate arterial hemorrhage 2
• Consider the use of tourniquets in life-threatening situations, although their application is more relevant to human medicine than veterinary medicine 2
• Administer tranexamic acid (TXA), an antifibrinolytic agent, to prevent fibrinolysis and reduce hemorrhage, with a recommended loading dose of 1 g followed by 1 g infusion over 8 hours 3, 4, 5, 6
• Elevate and splint (immobilize) any bleeding extremity or body part as an adjunctive aid for hemorrhage control when used in conjunction with other methods of control, especially direct pressure 2

Pharmacologic Interventions

• Tranexamic acid (TXA) has been shown to reduce mortality in trauma-related hemorrhage and is considered a safe and effective treatment option 3, 4, 5
• Other alternative blood products, such as prothrombin complex concentrate, fibrinogen concentrates, and desmopressin, may also be considered based on the clinical context 6
• Viscoelastic hemostatic assays, such as rotational thromboelastometry and thromboelastography, can help guide the use of these alternative products 6

Prehospital Setting

• The use of TXA in the prehospital setting is considered clinically and economically feasible, and its administration within a 3-hour window period of traumatic injury is recommended 3
• First responders, such as emergency medical technicians, should consider TXA as an adjunct therapy in the management of acute, severe traumatic and nontraumatic hemorrhage 4