As a cutman, my job is to tend to the cuts that fighters sustain during their bouts. The Association of Boxing Commissions has approved three coagulants/coagulates for use: Adrenaline Chloride 1:1000, Aventine, and Thrombin. Some state commissions like the Nevada state Athletic Commission have approved other coagulants, like Qwick-Aid, which may later be added to the list. This article, will focus on the three approved coagulates and Qwick-Aid.
The first thing for a cutman to understand is the natural coagulation process. How does the human body naturally stop bleeding? After the skin is ruptured and the blood starts flowing out, the capillaries constrict to limit the blood flow to the area. Then cells called platelets form a plug in the wound by changing shape and binding directly to collagen in the lining of the blood vessels. This first phase of stopping bloodflow is called primary hemostasis.
Secondary hemostasis occurs from a cascade of steps where clotting factors activate each other in turn. There are two pathways, but both pathways end with the conversion of the final clotting factor fibrinogen into its activated form called fibirin. Fibrin helps to make the final clot, fully sealing the wound. Each of the Association of Boxing Commissions approved coagulants for a cutman to use work on one of these levels.
The first coagulate used by a cutmen, Adrenaline Chloride 1:1000, also known as Epinephrine Chloride 1:1000, works as a vasoconstrictor, making the capillaries smaller to limit blood flow to the wound. To obtain adrenaline chloride 1:1000, you must have a prescription. Most doctors, when they write the script, will prescribe 1 mL ampules. This is convenient for the general public; however the 3 mL vial is more convenient for cutmen. Storage is not much of an issue since it is stable at room temperature; however it is light sensitive so make sure to just use the vial it comes in. Average cost is $9.00 for a single 3 mL vial. To prep your swab, simply remove the metal collar on top of the vial with your scissors, lift the rubber stopper, dip your swab in the bottle, replace the rubber stopper, and secure with a piece of tape. For cut, apply the swab with direct pressure. This is the most commonly used coagulate, due to its cost. Remember, when using swabs, keep them sterile! Don’t wipe them in a guy’s nose, then his mouth, and then the cut on his forehead bringing all the bacteria and other junk with it. This is one of Stitch’s main pieces of advice for a cutman in his two part interview with FightMedicine.net (Part 1 and Part 2)
The second step in the coagulation process is platelet formation,which is where the second approved coagulate, Aventine works at. Aventine is a Microfibrillar Collagen that is normally derived from plants. When applied to a cut, it speeds up the collection of platelets, to form a clot. You can obtain Aventine in two forms, either flour (powder) or in a sponge form, with a prescription. Aventine is more expensive than adrenaline chloride 1:1000. It ranges anywhere from $800 to $2,000, depending on what form you buy it in. The nice thing about Aventine is that it is stable at room temperature and is not light sensitive. To apply an Aventine sponge, simply remove it from its wrapper and apply it to the cut with direct pressure. To apply the Aventine flour, there are two methods. In one method, you apply the flour directly on the cut, which is messy and impractical, but can be done. The second method is to suspend the flour in 0.5% saline solution, dip your swab in that solution, and apply it to the cut with direct pressure. This coagulate is not used as commonly as Adrenaline Chloride 1:1000; however it is kept in some cutmen’s buckets.
The third step in the coagulation process is the fibrin migration to the site to form a fibrous clot. That is the level that Thrombin works at. Thrombin is either bovine (cow) derived or human derived and available in a powder or liquid form. Either form must be obtained by having a prescription and runs high on cost, usually starting at $400 and pricing goes up from there. The application process is the same as that of Aventine, however if you purchase the liquid, it must be refrigerated. This may be the most effective, but is not the most cost efficient so it is used the least.
Although only approved for use in Nevada at the time this article was written, Qwick-Aid is a promising option for cutmen. Qwick-Aid works on the platelet formation level of coagulation, but on a mechanical level instead of a chemical level. The main active ingredient in Qwick-Aid is Alginate, a seaweed based product that is absorbent and creates a gel while absorbing the blood. This increases the viscosity in the wound and trapping platelets at the site. It can be used with any of the other Association of Boxing Commissions coagulates, however it is highly effective alone. Available without a prescription and a box of 2”x2” bandages, 20 latex free waterproof tape strips will cost $114.50. The nice thing about Qwick-Aid, other than the fact that as a cutman you do not need a prescription, is that once the bleeding has stopped, you can tape a bandage over the wound, instead of packing it with Vaseline, and the cut will be protected and ready for the ringside doctor to suture.
Hopefully, this explanation of the coagulation process and products approved by the Association of Boxing Commissions gives those starting out as cutmen a primer to work with and those that have been cutmen an added review. And remember, the first principle in stopping any bleeding is simple compression!