A Qualitative Morphological Comparison of Two Haemostatic Agents in a Porcine Liver Trauma Model

Abstract

<p class="MsoNormal"> <br /> </p> <p class="MsoNormal"> <b><span lang="EN-GB">Background: </span></b><span lang="EN-GB">Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topical gelatine-based haemostatic agents in a porcine liver trauma model. <b>Methods: </b>We compared the activity of Floseal^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} (with human or bovine thrombin), Surgiflo^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} and Surgiflo^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} plus 5000 IU bovine thrombin per 10 mL of product (n = 6 test sites/group). Different clinical scenarios were evaluated in two anaesthetised piglets; normal physiological conditions (normotension and normothermia), and a status of hypotension, hypothermia and haemodilution, requiring inotropic support. Laparo</span><span lang="EN-GB">tomy was performed, and five identical stab wounds were made on each liver lobe. Four of these wounds were ran</span><span lang="EN-GB">domly treated with one of the agents under investigation, while one wound was kept as an untreated control. Haemosta</span><span lang="EN-GB">sis was observed during and immediately following surgery. After euthanisation, wounds were examined (blinded for treatment) macroscopically, microscopically and using scanning electron microscopic evaluation. <b>Results:</b> Surgiflo^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} produced some degree of clotting in 1/3 applications in both piglets. Co-treatment with thrombin resulted in a minor improvement in performance in the animal with normal physiological conditions (some degree of clotting in all wounds); no improvement was seen in the animal in a status of hypotension, hypothermia and haemodilution. Floseal^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} induced clotting in all wounds for both piglets. Microscopic and scanning electron microscope examination of the stab wounds demonstrated that Floseal^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} created a stable, dense agglomerate of gelatine and fibrin, which firmly adhered to the adjacent liver tissue. In wounds treated with Surgiflo^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} or Surgiflo^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} plus thrombin, the gelatine contained more air bubbles, resulting in less fibrin inclusion in the clot and weaker adhesion of the clot to the liver tissue.</span><span lang="EN-GB"> </span><b><span lang="EN-GB">Conclusion:</span></b><span lang="EN-GB"> Floseal^{<span style="font-size:12.0pt;font-family:" color:#004080;"="">?</span>} created a dense and stable blood clot, even in a piglet with hypotensio...

An Efficacy Comparison of Two Hemostatic Agents in a Porcine Liver Bleeding Model: Gelatin/Thrombin Flowable Matrix versus Collagen/Thrombin Powder

“…Additionally, significantly lower bleeding rates were observed with SmGM at 7 minutes for the low-intensity sub-set and at 7 and 11 minutes for the high-intensity sub-set. The efficacy of SmGM is in line with results from a previous study in which SmGM was able to induce clotting in all wounds in a porcine model with liver stab wounds under both normal physiological conditions and under conditions of hypotension, hypothermia, and hemodilution [23]. Similarly, in a porcine liver abrasion model, SmGM displayed superior hemostatic success when compared with a stellate gelatin hemostatic agent, with reduced bleeding and blood loss [24].…”

Efficacy of hemostatic matrix and microporous polysaccharide hemospheres

“…In doing so, hemostatic matrix gelatin conforms to wound surfaces by absorbing tissue fluid to create a tamponade effect [18]. The combination of these three mechanisms of action is likely the reason for its greater efficacy in this study and as reported by other investigators who have used hypocoagulopathic, hypothermic, or hemodilute animal models [11,18,19].…”

Can floseal™ be applied safely during otologic surgery? Assessment of ototoxicity in a chinchilla animal model

“…It can be applied on wet, actively bleeding tissues, conforms to irregular surfaces and has been shown to be more effective than gelfoam in heparinized patients [5]. After application of the Floseal matrix, the gelatin particles swell and tamponade the bleeding as the gelatin matrix-thrombin composite slows the blood flow and provides exposure to a high concentration of thrombin, hastening clot formation [6]. Particularly in conditions where patients need to be anti-coagulated, such as having a metallic cardiac valve or stent it would be useful to know whether hemostatic agents such as Floseal™ can safely be used without causing ototoxicity.…”