This is an interesting paper, trying to present documented data regarding the application of the many commercially available haemostatic products in controlling bleeding in cardiovascular surgery. A classification of these products in four major groups is presented and a systematic review of the literature on their advantages and disadvantages is attempted. The authors present interesting scenarios for the use of such products in cardiovascular surgery, subjectively suggesting the most appropriate. However, the article underlines once more the lack of significant scientific data in favor of any of the many haemostatic agents available on the market! And, as the paper correctly concludes, “the choice of topical haemostatic agents is dependent of the surgeon’s preference and on individual experience rather than on strong evidence based practice”. And one should emphatically add that good surgical technique in the control of bleeding cannot be replaced by any topical haemostatic product!

– Constantine Vagianos