Carbazochrome (Carbazochrome Sodium Sulfonate)
Evidence-Based Recommendation
Carbazochrome sodium sulfonate should not be used in clinical practice for bleeding management, as it lacks proven efficacy for reducing mortality, transfusion requirements, or clinically meaningful bleeding outcomes, and is not recommended by any major international guideline.
Current Evidence Status
Absence from Major Guidelines
No major international bleeding management guidelines—including those from the American College of Cardiology, European Society of Cardiology, American Association for the Study of Liver Diseases, or Association of Anaesthetists of Great Britain and Ireland—recommend carbazochrome for any bleeding indication 1.
Guidelines for massive hemorrhage management prioritize tranexamic acid, fresh frozen plasma, prothrombin complex concentrate, and platelet transfusion, with no mention of carbazochrome 1.
Research Evidence Shows Limited or No Benefit
Gastrointestinal Bleeding:
In 59,965 patients with colonic diverticular bleeding, carbazochrome showed no reduction in mortality (0.6% vs 0.5%, OR 0.96), no decrease in transfusion requirements, and actually increased length of stay by 0.44 days 2.
For post-gastric endoscopic submucosal dissection bleeding, carbazochrome was completely ineffective—bleeding occurred in 5.2% of carbazochrome patients vs 3.8% of controls (p=0.783), with no benefit even in high-risk patients 3.
Trauma:
- In 326 trauma patients receiving tranexamic acid, adding carbazochrome reduced red blood cell transfusion by a minimal amount (standard coefficient -0.1) but did not reduce mortality (15.1% vs 6% in controls) or affect fresh frozen plasma or platelet requirements 4.
Orthopedic Surgery:
- The only setting showing potential benefit is total hip arthroplasty, where carbazochrome combined with tranexamic acid reduced total blood loss compared to tranexamic acid alone 5, 6.
- However, this represents a controlled surgical setting with minimal generalizability to acute bleeding emergencies.
Why Carbazochrome Should Not Be Used
Lack of Mortality Benefit
- Across all studied populations, carbazochrome has never demonstrated a reduction in death—the most important clinical outcome 4, 2.
Inconsistent Efficacy
- Carbazochrome failed to prevent bleeding in gastrointestinal settings 3, 2.
- In trauma, it showed only marginal effects on red blood cell transfusion without affecting overall transfusion strategy 4.
Opportunity Cost
- Using carbazochrome delays or distracts from proven interventions such as tranexamic acid (which reduces trauma mortality), fresh frozen plasma, prothrombin complex concentrate, and definitive bleeding control 1, 7.
Evidence-Based Alternatives for Bleeding Management
For Massive Hemorrhage
Tranexamic acid: 1 g IV bolus over 10 minutes within 3 hours of injury, followed by 1 g infusion over 8 hours—proven to reduce mortality in trauma 1, 7.
Fresh frozen plasma: Early infusion at 15 ml/kg to prevent dilutional coagulopathy, with higher volumes needed for consumptive coagulopathy 1.
Platelet transfusion: Target platelet count ≥75 × 10⁹/L in massive hemorrhage 1.
Prothrombin complex concentrate: For warfarin reversal in life-threatening bleeding, 25-50 U/kg IV plus vitamin K 5-10 mg IV 1, 8.
For Specific Bleeding Scenarios
Variceal hemorrhage: Octreotide 50 mcg IV bolus followed by 50 mcg/hr infusion for 2-5 days, plus ceftriaxone 1 g IV daily 1.
Anticoagulant-related bleeding: Volume resuscitation with isotonic crystalloids, restrictive transfusion strategy (hemoglobin ≥7 g/dL), and specific reversal agents 1.
Critical Pitfalls
Do not use carbazochrome as a substitute for proven hemostatic interventions—it has no established role in acute bleeding management 1.
Do not delay tranexamic acid administration in trauma or massive hemorrhage to give carbazochrome—tranexamic acid must be given within 3 hours of injury for maximum benefit 1, 7.
Do not use carbazochrome in gastrointestinal bleeding—it has been specifically shown to be ineffective in this setting 3, 2.
Dosing Information (For Reference Only)
While carbazochrome is not recommended, the studied regimens were:
- Intravenous: 100 mg/day for 3 days 3, 2.
- Trauma setting: Dosing not standardized in studies 4.
- Orthopedic surgery: 10-20 mg intravenous or topical 5, 6.
No standard adult dosing exists because carbazochrome lacks regulatory approval in most Western countries and is not included in evidence-based guidelines.
Management of Persistent Bleeding
When bleeding persists despite initial interventions:
Identify and control the source: Early involvement of surgery, interventional radiology, or gastroenterology for definitive management 1.
Correct coagulopathy: Target fibrinogen >1.5 g/L, platelets >75 × 10⁹/L, and normal PT/aPTT 1.
Address hypothermia and acidosis: Both worsen coagulopathy and perpetuate bleeding 1.
Consider radiological embolization: Effective for pelvic, hepatic, and obstetric hemorrhage when surgical intervention is not feasible 1.
Escalate to massive transfusion protocol: Use fixed-ratio transfusion (1:1:1 of red cells:plasma:platelets) for ongoing hemorrhage 1.