Description

Ethamsylate is a hemostatic agent, meaning it helps to stop or prevent bleeding. It is a synthetic drug that works by acting on the initial stages of hemostasis, the body’s natural process for controlling bleeding. Unlike other agents that work on the coagulation cascade or fibrinolysis, ethamsylate focuses on improving the function of platelets and capillaries. It is available in oral, injectable, and topical forms.

Indications

Ethamsylate is primarily used to manage and prevent bleeding from small blood vessels (capillary bleeding). Its key indications include:

• Menorrhagia (Heavy Menstrual Bleeding): It is frequently used to reduce excessive menstrual blood loss.

• Surgical Procedures: It is used to minimize blood loss during and after delicate surgeries, particularly in fields such as ophthalmology, otolaryngology (ear, nose, and throat), gynecology, and dentistry.

• Periventricular Hemorrhage: It is used to prevent bleeding into the brain ventricles in premature infants.

• Other Bleeding Conditions: It can be used for various other conditions involving capillary bleeding, such as hematuria (blood in urine), hematemesis (vomiting blood), or epistaxis (nosebleeds).

Mechanism of Action

The exact and complete mechanism of action of ethamsylate is not fully understood, but it is believed to work through multiple pathways that enhance the initial steps of hemostasis. Its primary actions are on the capillary walls and platelets:

1. Increased Capillary Resistance: Ethamsylate is thought to strengthen the walls of the capillaries, making them more resistant to rupture. It is believed to do this by restoring the integrity of the endothelial lining and by influencing the synthesis of hyaluronic acid, a component of the extracellular matrix that provides structural support to blood vessels.

2. Enhanced Platelet Adhesion and Aggregation: The drug promotes platelet adhesion, the process where platelets stick to a damaged blood vessel wall. It is also believed to improve platelet aggregation, which is when platelets clump together to form a primary platelet plug. This is thought to involve the promotion of P-selectin-dependent platelet adhesive mechanisms and potentially by modulating prostaglandins that influence platelet function.

3. Inhibition of Prostaglandins: Ethamsylate inhibits the biosynthesis and action of certain prostaglandins, particularly prostacyclin (PGI2). Prostacyclin is a potent vasodilator and an inhibitor of platelet aggregation. By reducing its effects, ethamsylate creates a more favorable environment for vasoconstriction and platelet aggregation at the site of injury.