Absorbable hemostatic agents

Gabay, Michael

doi:10.2146/ajhp060003

Cited by 75 publications

(68 citation statements)

References 26 publications

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“…By reducing or depleting platelet function, antiplatelet therapy prevents thrombotic events but poses a significant risk for major bleeding complications in planned cardiac interventions as well as in elec-tive and emergency non-cardiac surgeries [3][4][5]. Topical hemostats and sealants can be used to mitigate such bleeding risks [6].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Severe Aortic Bleeding Using Hemopatch in Swine on Dual Antiplatelet Therapy

Baumgartner

Draxler

Lewis

2016

Journal of Investigative Surgery

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Purpose: The perioperative management of patients on antithrombotic therapy is currently an unresolved problem as these therapies pose a considerable risk for perioperative hemorrhagic complications. The presented studies investigated the efficacy of a new collagen technology to achieve hemostasis. A polyethylene glycol-coated collagen pad (PCC) was compared to a marketed fibrinogen-thrombin coated collagen pad (FTC) for the treatment of an aortotomy incision in heparinized swine on dual antiplatelet therapy. Materials and Methods: Twenty-eight 3-mm aortotomy incisions were created in nine heparinized pigs without antiplatelet therapy and treated with PCC. Sixty-eight aortotomy incisions were created in ten heparinized pigs that received clopidogrel (10-11 mg/kg) and acetylsalicylic acid (8-11 mg/kg) orally for 5 days, and treated with either PCC or FTC (N = 34/group). Dual antiplatelet therapy resulted in significantly reduced platelet function. Aortotomy incisions resulted in lifethreatening bleeding of 35-292 ml/min. Results: In animals without antiplatelet treatment, PCC provided 96% immediate hemostatic success. In animals with antiplatelet treatment, FTC provided 18% immediate hemostatic success increasing to 74% after 10 min. Strikingly, PCC provided 94% immediate success increasing to 100% after 10 min. Controlling for differences in pretreatment bleeding rates, statistical model-estimated time to hemostasis was 12 times shorter in PCC-treated lesions (p < .02). Conclusion: The combination of a procoagulant collagen pad with a synthetic sealing component provides excellent hemostatic properties under a worst-case scenario. PCC rapidly and firmly adheres to tissue, thereby controlling severe arterial bleeding, even when platelet function is significantly reduced. Treatment with PCC provided superior time to hemostasis compared to FTC.

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Section: Introductionmentioning

confidence: 99%

Treatment of Severe Aortic Bleeding Using Hemopatch in Swine on Dual Antiplatelet Therapy

Baumgartner

Draxler

Lewis

2016

Journal of Investigative Surgery

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“…2 Oxidised cellulose and porcine gelatine sponge have been in use since the 1940's. From the 1970's bovine collagen and flowable bovine collagen with bovine platelets or flowable bovine gelatine matrix mixed with bovine thrombin have been adopted.…”

Section: Case Presentationmentioning

confidence: 99%

“…The cellulose and gelatine preparations possibly activate clotting through contact activation, while the collagen based products act through a dual mechanism of contact activation and platelet aggregation. 2 The combination of a gelatine matrix and thrombin assists in the stabilisation of the resultant thrombus. Cellulose, being a plant product, is considered inert, 3 however the animal origin of the other products means that they contain biological activity with possible sequelae.…”

Section: Case Presentationmentioning

confidence: 99%

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

Gluch¹

2018

AMJ

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Please cite this paper as: Gluch L, Gluch N. A surgeon, a rabbi and a lawyer walk into an OR… Absorbable haemostatic agents and the dangers of product evolutionclinical, religious and legal implications. AMJ 2018;11 (1) ABSTRACTAdjunctive haemostatic agents have been used in surgery for over 70 years. What surgeons may not know is that products intended for similar applications may have very different biological properties and that occasionally product upgrades may introduce a change in the material's behaviour. Many of the agents employed to assist in haemostasis may have a biological (animal) origin. A recent case brought to light the need to recognise the possibility of biological interactions. As consideration into this surgical problem unfolded, religious and legal questions began to arise. Key WordsBreast reconstruction, haemostatics, adverse effects Implications for Practice: What is known about this subject?This case suggests the possibility that some "inert" haemostatic agents may result in allergic type reactions. It has not previously been reported. What new information is offered in this case study?The complex biological origin of haemostatic agents and the biological, religious and legal implications of using them.3. What are the implications for research, policy, or practice?

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“…While systemic factors are -Age, malnutrition, vitamin deficiency, zinc deficiency, trauma, hypovolaemia, hypoxia, anaemia, uremia, malignant disease, jaundice, corticosteroids, cytotoxic and antimetabolite drugs. [2][3][4][5][6][7][8] The present study has been carried out to evaluate role of local instillation of 1% feracrylum and haemocoagulase on wound healing.…”

Section: Introductionmentioning

confidence: 99%

Role of local instillation of one percent feracrylum and haemocogulase on wound healing

Singh¹,

Dhruv²,

Patle³

et al. 2016

Int J Res Med Sci

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Background: The introduction of increasingly complex and major surgical procedures during the last 50 years has inevitably been accompanied by greater problems in wound healing. Fortunately, modern surgery is relatively safe, certainly by comparison with situation 50 years ago, but it cannot be said that it is totally devoid of risks or complications, and problems of wound healing are encountered in every surgical specialty. Indeed, in various ways these complication account for a large part of morbidity and mortality of surgical treatment.The present study has been carried out to evaluate role of local instillation of 1% feracrylum and haemocoagulase on wound healing. Methods: The present study was carried out in 100 patients in the Department of General Surgery, S.S. Medical College and associated G.M. Hospital and Sanjay Gandhi Memorial Hospital, Rewa (M.P.), India. The material for the study comprised of randomly selected 100 patients. A thorough clinical examination was done to assess general condition of patients and systemic disorder. Local examination was done to make a surgical diagnosis and associated problem. In case of surgical emergency, on arrival of patient clinical examination was immediately started and history asked during resuscitation of the patient. All relevant procedures were performed before surgery. Appropriate surgical procedures were performed. Suitable local haemostatic was applied. The wound inspected on 3rd, 7th and 14th day of presence of swelling, tenderness, colour change, discharge, scar tissue and changes were recorded. Results: Most of the patients were between 21-30 years and 50 and above. The youngest being 3 years and the eldest being 75 years old. Majority of patients were operated for Perforation Peritonitis (28%) and Hernia (26%). Next common group was Intestinal Obstruction (9%) and Cholecystectomy (7%). Out of 100 cases operated 60 were as planned and rests were as emergency cases. 1% Feracrylum and Haemocoagulase was used in equal number of cases. In 24 cases 1% Feracrylum was instilled subcutaneously in 10 cases instilled at intermuscular level and in 16 cases instilled at both level. In 23 cases Haemocogulase was instilled subcutaneously in 14 cases instilled at intermuscular level and in 13 cases instilled at both level. All cases Skin Wound was closed in Interrupted fashion. Conclusions: Good surgical technique plays key role in post-operative wound healing. The essential of good surgical technique include gentle handling of tissues, meticulous haemostasis, and prevention of dead space in the wound and avoidance of tissue necrosis resulting from excessive use of diathermy or strangulation of tissues by Ligatures. 1% Feracrylum and Haemocoagulase are helpful in decreasing local infection rate by decreasing post-operative capillary oozing.

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Absorbable hemostatic agents

Abstract: Absorbable hemostatic agents are useful as adjunctive therapy during surgical procedures when conventional methods do not control bleeding. Although rare adverse effects have occurred with these agents, their careful administration will prevent serious adverse outcomes.

Cited by 75 publications

References 26 publications

Treatment of Severe Aortic Bleeding Using Hemopatch in Swine on Dual Antiplatelet Therapy

Treatment of Severe Aortic Bleeding Using Hemopatch in Swine on Dual Antiplatelet Therapy

A surgeon, a rabbi and a lawyer walk in to an OR… Absorbable haemostatic agents and the dangers of product evolution – clinical, religious and legal implications

Role of local instillation of one percent feracrylum and haemocogulase on wound healing

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