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The mainstays of systemic treatment for acute hemorrhage are fluid therapy and blood transfusion. There are a number of procoagulant medications that can also be used to enhance hemostasis in the horse [39]:

 Formalin – Proposed to enhance endothelial or platelet activation, reported dose of 10–100 ml of 10% formalin in 1 L isotonic saline

 Aminocaproic acid – Lysine derivative that inhibits fibrinolysis by binding plasminogen activators and enhancing antiplasmin activity. The previously reported doses are 10–40 mg/kg IV q6h slow in saline or 3.5 mg/kg/min for 15 min then 0.25 mg/kg/min constant rate infusion.

 Tranexamic acid – Similar mechanism of action as aminocaproic acid; 5 g IV every 12 hours or 10 g PO every 6 hoursNew research suggests that as little as 1/20 of the published doses of aminocaproic acid and tranexamic acid may be effective in horses [40].

 Conjugated estrogens – May polymerize mucopolysaccharides in vessel walls or decrease antithrombin activity, 0.6 mg/kg IV every 24 hours

 Yunnan baiyao – Chinese herbal medication with demonstrated hemostatic efficacy, possibly due to activation of platelets, enhanced expression of surface glycoproteins on platelets [41].