Comparison of hemostatic dressings for superficial wounds using a new spectrophotometric coagulation assay

Abstract

BackgroundDue to demographical changes the number of elderly patients depending on oral anticoagulation is expected to rise. Prolonged bleeding times in case of traumatic injuries represent the drawback of these medications, not only in major trauma, but also in superficial wounds. Therefore, dressings capable of accelerating coagulation onset and shortening bleeding times are desirable for these patients.MethodsThe hemostatic potential and physical properties of different types of superficial wound dressings (standard wound pad, two alginates, chitosan, collagen (Lyostypt®), oxidized cellulose, and QuikClot®) were assessed in vitro. For this purpose the clotting times of blood under the influence of the named hemostatics from healthy volunteers were compared with Marcumar® or ASS® treated patients. For that, a newly developed coagulation assay based on spectrophotometric extinction measurements of thrombin activity was used.ResultsThe fastest coagulation onset was observed for oxidized cellulose (Ø 2.47 min), Lantor alginate-l (Ø 2.50 min) and QuikClot® (Ø 3.01 min). Chitosan (Ø 5.32 min) and the collagen Lyostypt® (Ø 7.59 min) induced clotting comparatively late. Regarding physical parameters, QuikClot® showed the lowest absorption capacity and speed while chitosan and both alginates achieved the highest. While oxidized cellulose displayed the best clotting times, unfortunately it also revealed low absorption capacity.ConclusionsAll tested specimens seem to induce clotting independently from the administered type of oral anticoagulant, providing the possibility to neglect the disadvantage in clotting times arising from anticoagulation on a local basis. QuikClot®, oxidized cellulose and unexpectedly alginate-l were superior to chitosan and Lyostypt®. Due to its additional well-known positive effect on wound healing alginate-l should be considered for further investigations.

An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models

“…In a comparison performed in healthy humans, ORC produced faster coagulation than alginates, chitosan and collagen, and was also effective in subjects taking anticoagulants. 10 Hemostatic costs have been shown to be substantially lower for ORC products, such as SF, when compared to other adjunctive hemostats. 11 , 12 …”

Using calcium sulfate cement—Hydroxypropyl methyl cellulose/sodium alginate composites as substitutes of bone wax

“…In addition, CSC itself can work not only as a physical barrier to stop bleeding like bone wax, but also as an adsorption site for blood proteins to start intrinsic coagulation pathway. Meanwhile, both HPMC and SA are highlighted with their water adsorption capacity to concentrate blood to induce coagulation . Therefore, for the aspects of blood clotting, the addition of both HPMC and SA are recommended to enhance the hemostatic ability of CSC.…”

Hemostatic wound dressings: Predicting their effects by in vitro tests

“…There have only been few reports on comparative studies performed in a controlled in vitro environment with human blood and plasma to assess the basic hemostatic properties of commercially available hemostatic dressings. 1, 6, 17–20 Historically, reports in this field have focused on animal trials using specific organ lacerations, arterial puncture, and skin injury models to evaluate hemostatic efficacy. 21–26 Such animal models are still widely used.…”