State-of-the-Art Review: Hemostats, Sealants, and Adhesives II: Update As Well As How and When to Use the Components of the Surgical Toolbox

Spotnitz, William D.; Burks, Sandra G.

doi:10.1177/1076029610363589

Cited by 145 publications

(215 citation statements)

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“…[5] Substantial data indicate that some mineral-based hemostatic agents (capable of clotting blood) such as kaolin,[6–8] zeolite[9,10] or chitosan that is a linear polysaccharide[11–13] significantly decrease the hemostasis time. Spotnitz and Burks[14,15] have recently compared some major FDA-approved topical hemostatic agents including sealants that provide a sealing barrier and adhesives that bond tissues together.…”

Section: Introductionmentioning

confidence: 99%

CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding

Mortazavi

Tavasoli²,

Atefi

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:Uncontrolled bleeding is the first leading cause of preventable death in the battlefield and the 2nd cause of mortality in civil accidents. Incompressible hemorrhage control is among the interventions that drastically increase the survival rate in wound individuals. We have previously shown that a certain mixture of bentonite and zeolite minerals can significantly decrease the bleeding in rats.METHODS:In this study, nine healthy hybrid dogs were selected and after induction of anesthesia with ether, either arterial puncture by a needle or arteriotomy was performed on both groin regions of the dogs. For control arteries (either the right or left femoral artery), only pressure by sterilized gauze was performed, while for the femoral arteries of the opposite side, our invented hemostatic agent, namely CoolClot, was topically used before applying the pressure. In the second stage of the study, to assess the coagulation time, blood samples were collected from 10 volunteer students.RESULTS:CoolClot significantly decreased the bleeding time in animals whose femoral arteries were cut or punctured. In the human phase of the study, the mean coagulation time in control blood samples was 253.4±44.1 seconds, whereas it was 149.5±50.0, 162.3±74.6 and 143.4±114.6 seconds, respectively in blood samples treated with bentonite, zeolite and CoolClot (P<0.05).CONCLUSIONS:As controlling bleeding after a life-threatening arterial damage is critical for increasing the chance of survival, the results obtained in this study indicate the significant efficacy of CoolClot in shortening the bleeding time. Our experiments also indicate that CoolClot can significantly reduce the clotting time in human blood samples.

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Section: Introductionmentioning

confidence: 99%

CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding

Mortazavi

Tavasoli²,

Atefi

et al. 2013

World Journal of Emergency Medicine

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“…Surgiflo ® consists of 6 ml porcine gelatin which can be mixed either with 2-5 ml saline solution or with 2,000 IU lyophilized human thrombin, resulting in 8-11 ml ready-touse hemostat (12, 29). The flowable consistency and portionability allow application to irregular and diffuse bleeding surfaces (12,30).In the field of gynecological surgery, excluding our own preliminary data of 2012 (21), we identified only one comparison of 25 cases and 25 controls focusing on Floseal ® use and PBL (20). In abdominal conservative myomectomy, HM use was associated with decreased PBL and lower transfusion rates (20).…”

mentioning

confidence: 99%

“…due to use of oral anticoagulant. In the past two decades, an increasing number of topical hemostats, sealants and adhesives have been available to surgeons (1,12). Hemostatic gelatin-thrombin matrix (HM) (Floseal ® ; Baxter Healthcare, Deerfield, IL, USA) is a locally applicable hemostatic agent, registered for support of local hemostasis when conventional hemostatic maneuvers are ineffective or impractical.…”

mentioning

confidence: 99%

“…due to use of oral anticoagulant. In the past two decades, an increasing number of topical hemostats, sealants and adhesives have been available to surgeons (1,12 in vivo 31: 251-258 (2017) …”

mentioning

confidence: 99%

“…Floseal ® is prepared by operating theater staff within 1-2 minutes and can be used for up to 8 h thereafter. Since contact with fibrinogen is essential for the action of thrombin, HM should be applied directly to the bleeding tissue, but never into blood vessels (12,13). After 2 min of action, all excess HM not incorporated into the clot is removed by irrigation (13).…”

mentioning

confidence: 99%

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Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic–Oncological Surgery with Hemostatic Gelatin–Thrombin Matrix

Watrowski

Jäger

Förster

2017

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Abstract. Aim: To assess the impact of the use of intraoperative hemostatic gelatin-thrombin matrix (HM)( (168 vs. 199 min, p=0.02) and hospitalization (9 vs. 14 days, p<0.001) times. The mean postoperative Hb drop (3.33 vs. 4.51 g/dl, p<0.001), and the mean postoperative increase in CRP (94.9 vs. 149.1 mg/l, p<0.001) were significantly less pronounced within the HM group. Despite more prevalent coagulopathy (48 vs. 31%, p=0.02), e.g. due to anticoagulant use (15.7 vs. 3%, p<0.001), patients treated using HM needed less frequent transfusions of packed red blood cells [odds ratio (OR)= 0.13, 95% confidence interval (CI) =0.07-0.24) and fresh frozen plasma (OR=0.51,. In comparison to controls, the need for surgical revisions (OR 0.1,) and intensive-care unit admissions (OR 0.15, Intraoperative bleeding is a complication of gynecological surgery (1, 2). Increased perioperative blood loss (PBL) disrupts the operation, impairs organ exposure, contributes to prolonged surgical and hospitalization times, increases the need for transfusion, and negatively impacts therapy costs (1, 3). In non-oncological gynecological surgery, acute postoperative hemorrhage is the most frequent cause of returning to the operating theater (2). A PBL of more than 1 l complicates 15-40% of radical oncological operations, resulting in transfusion rates of 30-60% (4-6). In general surgery, intraoperative transfusion of only one to two units of packed red blood cells (PRBC) has been shown to significantly elevate the risk for surgical-site infection, pneumonia, sepsis and 30-day mortality (7). In gynecological patients, blood transfusions are clearly associated with increased surgical wound infections and composite morbidity and mortality (8). Additionally, a low perioperative hemoglobin (Hb) level and blood transfusions themselves may worsen the prognosis of pelvic cancers (9, 10). Typical intraoperative hemostatic maneuvers comprise of compression, sutures, clips and electrocoagulation. However, in some cases, conventional hemostasis can be insufficient (e.g. due to intraoperative coagulopathy), unsafe (e.g. due to proximity of structures sensitive to thermal damage) or impractical (e.g. diffuse bleeding area) (1, 11). Additionally, a subset of patients undergoing surgery have impaired hemostasis, e.g. due to use of oral anticoagulant. In the past two decades, an increasing number of topical hemostats, sealants and adhesives have been available to surgeons (1,12 in vivo 31: 251-258 (2017) Patients and MethodsPatients and definitions. This was a retrospective single-center study, conducted at the St. Josefskrankenhaus, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany. The study period was January 1, 2008 to October 30, 2013. The study was approved by the Institutional Review Board of the University of Freiburg (Reference No. 194/12), and was registered with the German Clinical Trials Register (DRKS), a primary register of the WHO International Clinical Trials Registry Platform, trial number DRKS00004...

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Chitin and Chitosan as Hemostatic Agents

Sundaram

Mony

Jayakumar

2016

Encyclopedia of Polymer Science and Technology

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Hemostatic agents can facilitate a rapid and effective hemostasis, thereby controlling the loss of blood during massive hemorrhage. Numerous biological‐ and nonbiological‐based hemostatic agents are widely used in clinics for control of bleeding. The use of biologically active agents to bring about hemostasis has a few disadvantages, such as their origin, handling procedure, and potential for disease transmission. Nonbiological agents, such as chitin and chitosan, gained popularity as hemostatic agents as they do not depend on the native coagulation cascade to control bleeding. Several FDA‐approved commercially available hemostatic agents are derived from chitin and chitosan. Chitosan bandage is even used in military as it could bring about rapid hemostasis during massive hemorrhage. This article presents various hemostatic agents used for bleeding control. We particularly focus on the chemical structure and properties of chitin and chitosan that give them hemostatic properties. Advantages of using chitin and chitosan as hemostatic agents are also discussed.

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State-of-the-Art Review: Hemostats, Sealants, and Adhesives II: Update As Well As How and When to Use the Components of the Surgical Toolbox

Cited by 145 publications

References 83 publications

CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding

CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding

Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic–Oncological Surgery with Hemostatic Gelatin–Thrombin Matrix

Chitin and Chitosan as Hemostatic Agents

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