Möglichkeiten der lokalen und systemischen Blutstillung bei chirurgischen Eingriffen

Abstract

Surgery inevitably leads to bleeding, and hemostasis aims at reducing the amount of blood loss and the need for transfusion as well as preventing rebleeding, hematoma formation, and the need for repeat surgery. Various locally applicable agents are in use including bone wax, gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues. Some evidence from randomized controlled trials (RCT) exists regarding the use of fibrin sealants on their own or combined with collagen fleece. Systemic hemostasis may be achieved with lysine analogs such as epsilon-aminocaproic acid or tranexamic acid and aprotinin, which are inhibitors of fibrinolysis. There is much albeit sometimes conflicting evidence from RCT regarding the use of these substances in surgery. The role of recombinant activated factor VII in achieving systemic hemostasis is being investigated.

A randomized, controlled, prospective trial to evaluate the haemostatic effect of Lyostypt versus Surgicel in arterial bypass anastomosis: "COBBANA" trial

“…For topical haemostasis bone wax, and various other topical haemostatic agents (powdered oxidized cellulose in polyethylene glycol wax, oxidized cellulose, gelatine paste, microfibrillar collagen, gelatine sponge soaked in thrombin) are currently in use [ 19 ]. Haemostasis is achieve through the physical, mechanical (bone wax, gelatine, oxidized cellulose) and chemical effect (microfibrillar collagen) of these materials [ 15 , 19 ]. Bone wax is non-absorbable whereas the other haemostatic agents are absorbed within days and weeks.…”

Experience with TachoSil in obstetric and gynecologic surgery

“…These agents have proved to be effective in improving surgical results, preventing early postoperative complications, reducing the duration of the intervention, and reducing the duration of postoperative hospitalization [3,4].…”

“…Since the early 1990s, a variety of hemostatic agents, such as fleeces of various origins, liquid fibrin sealants, an albumin-glutaraldehyde sealant, and synthetic glues, have been introduced as means to obtain satisfactory control of hemostasis during a range of surgical procedures. These agents have proved to be effective in improving surgical results, preventing early postoperative complications, reducing the duration of the intervention, and reducing the duration of postoperative hospitalization [3,4].…”

Efficacy of Different Hemostatic Devices for Severe Liver Bleeding: A Randomized Controlled Animal Study

“…9 These techniques include diathermy, argon beamer coagulation, 10 Pringle maneuver, 11 total vascular exclusion, 12,13 and use of topical agents such as oxidized regenerated cellulose, 14 absorbable gelatin sponge, 15 microfibrillar collagen, 9,15 and fibrin sealant. [16][17][18][19][20][21][22][23] Currently, the product TachoSil (Nycomed Deutschland GmbH, Konstanz, Germany), an equine collagen compress coated with fibrinogen and thrombin (PECo, for protein-coated equine collagen), is the most effective compress available. Its efficacy and safety for hemostatic treatment are well documented both in animal models 14 and in controlled human, prospective randomized trials.…”