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LyBarger KS. Review of Evidence Supporting the Arista™ Absorbable Powder Hemostat. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:173-188. [PMID: 38800552 PMCID: PMC11127658 DOI: 10.2147/mder.s442944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background Uncontrolled and diffuse bleeding is a dreaded event during open and laparoscopic surgery that may lead to postoperative complications, obstruction of the surgical field that reduces visualization, and prolonged operating times. Powder hemostats can be used to control bleeding and are easy to use, have a safe profile, and can achieve broad coverage area at a low cost. Methods A strategic literature search of peer-reviewed, English language studies was conducted to capture evidence on the clinical efficacy and safety of a Microporous Polysaccharide Hemosphere (MPH) based Hemostat (Arista™ Absorbable Hemostat (Arista™ AH)). Results Six preclinical studies were found which supported the use of MPH in various animal models of laparoscopic and open surgery, all of which demonstrated its safety and efficacy. Five single-arm and 11 comparative clinical studies similarly supported the efficacy and safety of MPH in various surgery types, including cardiac, renal, and dermatologic surgery. Conclusion Published evidence supports the safe and effective use of MPH across a variety of surgical settings.
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Deng J, Wang Z, Xing J. Rapid hemostatic antibacterial self-gelling powder based on methacryloylsulfonyl betaine and quaternized carboxymethyl chitosan. J Mech Behav Biomed Mater 2023; 146:106079. [PMID: 37634426 DOI: 10.1016/j.jmbbm.2023.106079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
Hemostatic powders can be used for deep wounds and wounds with irregular shapes that are frequently inaccessible to traditional hemostatic dressings like hemostatic gauze, sponges, and foams. In this study, sulfobetaine methacrylate (SBMA) and quaternized carboxymethyl chitosan (QCCS) were combined to create an antibacterial hemostatic hydrogel through photopolymerization under green LED irradiation, which was then changed into PSBMA/QCCS powder. PSBMA/QCCS powder could quickly form hydrogel with strong wet adhesion. The internal structure, water absorption capacity, and adhesion properties of the powder were evaluated. The coagulation ability, antimicrobial properties, and biocompatibility of the powder were also characterized. The PSBMA/QCCS powder could aggregate blood cells and platelets to enhance hemostasis. Meanwhile, PSBMA/QCCS powder also showed effective antibacterial ability against both gram-positive bacteria (Staphylococcus aureus) and gram-negative bacteria (Escherichia coli). In summary, PSBMA/QCCS powder is a promising hemostatic agent with the characteristics of quick hemostasis, tough wet adhesion, satisfactory biocompatibility, considerable antibacterial effect, and adaptability to any irregularly shaped wounds.
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Affiliation(s)
- Junxia Deng
- School of Chemical Engineering and Technology, Tianjin University, No. 135 Yaguan Road, Haihe Education Park, Jinnan District, Tianjin 300350, China
| | - Zhen Wang
- School of Chemical Engineering and Technology, Tianjin University, No. 135 Yaguan Road, Haihe Education Park, Jinnan District, Tianjin 300350, China
| | - Jinfeng Xing
- School of Chemical Engineering and Technology, Tianjin University, No. 135 Yaguan Road, Haihe Education Park, Jinnan District, Tianjin 300350, China.
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Liu C, Liu Z, Wang J, Bai Y, Sun X, Yang Q, Ma X, Zhou H, Yang L. Development of polydopamine functionalized porous starch for bleeding control with the assistance of NIR light. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2023; 34:1876-1890. [PMID: 36938635 DOI: 10.1080/09205063.2023.2193497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/21/2023]
Abstract
Efficient hemorrhage control of severe wound injuries is an urgent medical need, deserving agents with promising blood coagulation and biocompatible characteristics. Current work developed polydopamine (PDA) functionalized porous starch powder (PS-PDA) for emergency bleeding treatment. The micro-morphology and elements, chemical groups, and porosity of PS-PDA were systematically characterized. Its comparison with porous starch (PS) revealed the promising potential of this composite in medical practice. On one hand, PS-PDA showed superior surface area and biomineralization affinity over PS, along with comparable hemo/cyto-compatibility. On the other hand, the photothermal effect of PDA under near Infrared (NIR) light paved the possibility to accelerate blood coagulation in situ. In vivo studies indicated PS-PDA can significantly reduce blood loss and improvement of hemostasis efficiency accompanied by NIR light exposure. These results suggest that this newly developed PS-PDA powder can serve as a promising hemostatic material for bleeding wound control.
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Affiliation(s)
- Chuang Liu
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Ziyang Liu
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jie Wang
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Yanjie Bai
- School of Chemical Engineering, Hebei University of Technology, Tianjin, China
| | - Xun Sun
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Qiang Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Xinlong Ma
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Huan Zhou
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Lei Yang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, China
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Capella-Monsonís H, Shridhar A, Chirravuri B, Figucia M, Learn G, Greenawalt K, Badylak SF. A Comparative Study of the Resorption and Immune Response for Two Starch-Based Hemostat Powders. J Surg Res 2023; 282:210-224. [PMID: 36327703 DOI: 10.1016/j.jss.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Powder hemostats are valuable adjuncts to minimize intraoperative and postoperative complications. In addition to promotion of rapid coagulation, resorption, and biocompatibility are desirable attributes. Plant starch-based polysaccharide hemostat powders are effective and widely used hemostatic agents, however their source and/or processing can affect characteristics such as in vivo degradability. For example, Arista is a purified/hydrolyzed starch powder that is rapidly resorbed in vivo; whereas PerClot shows slow resorption and preservation of a crystalline form. MATERIALS AND METHODS In the present study, we compared the cellular response to the hemostatic agents PerClot and Arista both in vitro and in vivo, and used potato starch and urinary bladder extracellular matrix (UBM-ECM) as high crystallinity/slowly resorbable and prohealing controls, respectively. RESULTS All test articles and their degradation products were cytocompatible in vitro as measured by cell viability and metabolic activity of bone-marrow macrophages. PerClot induced a stronger proinflammatory, M1-like macrophage response in vitro (P < 0.001) than Arista, likely due to differences in source composition. Histologic examination of the in vivo surgical site showed the almost complete degradation of Arista after 12 h (day 0), whereas both PerClot and potato starch were still present at 28 d with crystals identifiable with polarized light microscopy and periodic acid Schiff (PAS) staining. Macrophage phenotype in vivo showed no differences between PerClot and Arista. Collagen deposition and mononuclear cell accumulation consistent with an early foreign body response were present around PerClot and potato starch crystals, whereas no such cell or connective tissue deposition was noted at the site of Arista or UBM-ECM placement.
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Affiliation(s)
- Héctor Capella-Monsonís
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arthi Shridhar
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bharadwaj Chirravuri
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Figucia
- BDI Surgery, Becton, Dickinson and Company, Warwick, Rhode Island
| | - Greg Learn
- BDI Surgery, Becton, Dickinson and Company, Warwick, Rhode Island
| | - Keith Greenawalt
- BDI Surgery, Becton, Dickinson and Company, Warwick, Rhode Island
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Bioabsorbable Carboxymethyl Starch-Calcium Ionic Assembly Powder as a Hemostatic Agent. Polymers (Basel) 2022; 14:polym14183909. [PMID: 36146054 PMCID: PMC9505345 DOI: 10.3390/polym14183909] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
In contrast to hemostatic fabrics, foams, and gels, hemostatic spray powders may be conveniently applied on narrow and complex bleeding sites. However, powdered hemostatic agents are easily desorbed from the bleeding surface because of blood flow, which seriously decreases their hemostatic function. In this study, the hemostatic performance of a bioabsorbable powder with decreased desorption was investigated. The proposed hemostatic powder (OOZFIXTM) is an ionic assembly of carboxymethyl starch and calcium. The microstructure and chemical properties of the hemostatic powder were analyzed. The hemostatic performance (blood absorption, blood absorption rate, and coagulation time), thromboelastography (TEG), rheology, adhesion force, and C3a complement activation of the OOZFIXTM were evaluated and compared with those of the carboxymethyl starch-based commercial hemostatic powder (AristaTM AH). The in vivo rat hepatic hemorrhage model for hemostasis time and bioabsorption of the OOZFIXTM showed quick biodegradation (<3 weeks) and a significantly improved hemostasis rate (78 ± 17 s) compared to that of AristaTM AH (182 ± 11) because of the reduced desorption. The bioabsorbable hemostatic powder OOZFIXTM is expected to be a promising hemostatic agent for precise medical surgical treatments.
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Nagrath M, Bince D, Rowsell C, Polintan D, Rezende-Neto J, Towler M. Porcine liver injury model to assess tantalum-containing bioactive glass powders for hemostasis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:53. [PMID: 35670885 PMCID: PMC9174136 DOI: 10.1007/s10856-022-06674-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
This study evaluates compositions of tantalum-containing mesoporous bioactive glass (Ta-MBG) powders using a porcine fatal liver injury model. The powders based on (80-x)SiO2-15CaO-5P2O5-xTa2O5 compositions with x = 0 (0Ta/Ta-free), 1 (1Ta), and 5 (5Ta) mol% were made using a sol-gel process. A class IV hemorrhage condition was simulated on the animals; hemodynamic data and biochemical analysis confirmed the life-threatening condition. Ta-MBGs were able to stop the bleeding within 10 min of their application while the bleeds in the absence of any intervention or in the presence of a commercial agent, AristaTM (Bard Davol Inc., Rhode Island, USA) continued for up to 45 min. Scanning electron microscopy (SEM) imaging of the blood clots showed that the presence of Ta-MBGs did not affect clot morphology. Rather, the connections seen between fibrin fibers of the blood clot and Ta-MBG powders point towards the powders' surfaces embracing fibrin. Histopathological analysis of the liver tissue showed 5Ta as the only composition reducing parenchymal hemorrhage and necrosis extent of the tissue after their application. Additionally, 5Ta was also able to form an adherent clot in worst-case scenario bleeding where no adherent clot was seen before the powder was applied. In vivo results from the present study agree with in vitro results of the previous study that 5Ta was the best Ta-MBG composition for hemostatic purposes. Graphical abstract.
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Affiliation(s)
- Malvika Nagrath
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada.
| | - Danielle Bince
- Research Vivarium, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
| | - Corwyn Rowsell
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, M5S 1A1, ON, Canada
| | - Deanna Polintan
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada
| | - Joao Rezende-Neto
- Trauma and Acute Care, General Surgery, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Surgery, University of Toronto, Toronto, M5S 1A1, ON, Canada
| | - Mark Towler
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Mechanical and Industrial Engineering, FEAS, Ryerson University, Toronto, M5B 2K3, ON, Canada
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Zhang X, Jiang L, Li X, Zheng L, Dang R, Liu X, Wang X, Chen L, Zhang YS, Zhang J, Yang D. A Bioinspired Hemostatic Powder Derived from the Skin Secretion of Andrias davidianus for Rapid Hemostasis and Intraoral Wound Healing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2101699. [PMID: 34817129 DOI: 10.1002/smll.202101699] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/20/2021] [Indexed: 06/13/2023]
Abstract
High-performance hemostasis has become increasingly essential in treating various traumas. However, available topical hemostats still have various drawbacks and side-effects. Herein, hemostatic powders derived from the skin secretion of Andrias davidianus (SSAD) with controllable particle size are prepared using feasible frozen-ball milling following lyophilization for hemorrhage-control. Scanning electron microscopy, rheometry, and Brunauer-Emmett-Teller test are used to characterize the coagulation-promoting surface topography, rheological properties, and porous structure of the SSAD particles. The blood-coagulation assays showed that the SSAD powders can induce blood-absorption in a particle size-dependent manner. Particle sizes of the SSAD powders larger than 200 µm and smaller than 800 µm greatly affect the blood-clotting rate. Associated with the thromboelastography (TEG) and amino acid/protein composition analyses, the accessibility and diffusion of blood are mainly dependent on the wettability, adhesivity, and clotting factors of the SSAD particles. Rapid hemostasis in vivo further involves three hemorrhage models (liver, femoral artery, and tail) as well as an oral wound model, which suggest favorable hemostatic and simultaneous regenerative effects of the SSAD hemostatic powder. Considering its degradability and good biocompatibility, SSAD can be an optimal candidate for a new class of inexpensive, natural, and promising hemostatic and wound-dressing agent.
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Affiliation(s)
- Ximu Zhang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Lin Jiang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Xian Li
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Liwen Zheng
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Ruyi Dang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Xiang Liu
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Xiaoping Wang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Liling Chen
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Jixi Zhang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Deqin Yang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, China
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Byun Y, Kim EJ, Lee A, Suh YA, Sohn HJ, Lee JM, Kang JS, Choi YJ, Han Y, Kim H, Kwon W, Jang JY. In vivo study for the hemostatic efficacy and foreign body reaction of a new powder-type polysaccharide hemostatic agent. Ann Surg Treat Res 2022; 102:65-72. [PMID: 35198509 PMCID: PMC8831091 DOI: 10.4174/astr.2022.102.2.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Various hemostatic agents have been introduced in therapy as postoperative bleeding is a poor prognostic factor for postoperative outcomes. These products can be divided into those that directly promote the hemostatic cascade and those that physically form a barrier by absorbing blood. The latter, powder-type hemostatic agents have the advantages of being inexpensive and more absorbable with less foreign body reactions (FBRs) and are applicable to a relatively wide area. This study was conducted to verify the safety and efficacy of a newly invented polysaccharide product (OOZFIX, Theracion Biomedical), which improves blood absorption and hemostatic effects. Methods Two separate animal experiments were performed. The first evaluated FBRs histologically at 3 days, 2 weeks, and 4 weeks, after implantation of OOZFIX in rats, and the second compared hemostatic performance of OOZFIX and Arista AH (Bard) in the porcine liver punch biopsy model. Results We found minimal FBRs in the 3-day group and no reactions in both the 2-week and 4-week groups after implantation of hemostatic agents. The time to hemostasis of OOZFIX was not significantly different from that of Arista AH (median [interquartile range]: 9 [6–10] minutes vs. 8 [6–10] minutes, respectively; P = 0.522). When comparing the serial bleeding grade tendency, there was no statistical difference between OOZFIX and Arista AH (P = 0.656). Conclusion OOZFIX caused a minimal FBR that disappeared within 2 weeks in vivo, and its hemostatic performance was comparable with that of an existing agent, Arista AH. Further clinical studies are required in the future.
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Affiliation(s)
- Yoonhyeong Byun
- Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Eun Jin Kim
- Theracion Biomedical Co., Ltd., Seongnam, Korea
| | - Areum Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young-Ah Suh
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hee Ju Sohn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Jin Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Youngmin Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Arunagiri V, Tsai HC, Darge HF, Chiang HW, Thankachan D, Mei CJ, Lai JY. Preparation of physically crosslinked polyelectrolyte Gelatin-Tannic acid-κ-Carrageenan (GTC) microparticles as hemostatic agents. Int J Biol Macromol 2021; 191:324-334. [PMID: 34530038 DOI: 10.1016/j.ijbiomac.2021.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022]
Abstract
In humans, excessive bleeding during civilian accidents, and surgery account for 40% of the mortality worldwide. Hence, the development of biocompatible hemostatic materials useful for rapid hemorrhage control has become a fundamental research problem in the biomedicine community. In this study, we prepared biocompatible gelatin-tannic acid-κ-carrageenan (GTC) microparticles using a facile Tween 80 stabilized water-in-oil (W/O) emulsion method for rapid hemostasis. The formation of GTC microparticles occurs via polyelectrolyte interactions between gelatin and k-carrageenan as well as hydrogen bonding from tannic acid. In addition, the GTC microparticles formulated in our study showed high water adsorption ability with a low volume-swelling ratio for a particle size of 46 μm. In addition, the GTC microparticles displayed >80% biocompatibility in NIH 3T3 cells and <5% hemocompatibility in hemolysis ratio tests. Notably, the GTC microparticles induced rapid blood clotting in 50 s and blood loss of approximately 46 mg in the femoral artery of BALB/c female mice with a 100% survival rate that was significantly better than the control group (blood clot time:250 s; blood loss: 259 mg). Thus, the findings from our study collectively suggest that GTC microparticles may play a promising clinical role in medical applications to tackle hemorrhage control.
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Affiliation(s)
- Vinothini Arunagiri
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC
| | - Hsieh-Chih Tsai
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC; Advanced Membrane Materials Centre, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC; R&D Centre for Membrane Technology, Chung Yuan Christian University, Chungli, Taoyuan 320, Taiwan, ROC.
| | - Haile Fentahun Darge
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC; College of Medicine and Health Science, Bahir Dar University, Bahir Dar 79, Ethiopia
| | - Hung Wei Chiang
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC
| | - Darieo Thankachan
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC
| | - Chia-Jui Mei
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC
| | - Juin-Yih Lai
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC; Advanced Membrane Materials Centre, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC; R&D Centre for Membrane Technology, Chung Yuan Christian University, Chungli, Taoyuan 320, Taiwan, ROC
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10
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Zhu J, Wu Z, Sun W, Meng Z, Zhu X, Gan H, Gu R, Guo X, Dou G. Hemostatic Efficacy and Biocompatibility Evaluation of a Novel Absorbable Porous Starch Hemostat. Surg Innov 2021; 29:367-377. [PMID: 34551638 DOI: 10.1177/15533506211046100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel absorbable porous starch hemostat (APSH) based on calcium ion-exchange crosslinked porous starch microparticles (Ca2+CPSM) was developed to improve hemostasis during surgeries for irregular cuts. The aim of this study was to compare its hemostatic efficacy and biocompatibility in a standard rat liver injury model relatively to Arista AH, Quickclean, and crosslinked porous starch microparticles (CPSM, without calcium ion). METHODS 72 Wistar rats (220g-240 g) were randomly assigned to six groups (Arista, Quickclean, CPSM, Ca2+CPSM, native potato starch, and untreated control group, n =12 per group). 30 mg of each hemostatic agent was applied to a standard circular liver excision (8 mm in diameter and 3 mm deep) in rats. Following their hemostatic efficacy, in vivo biocompatiblity evaluation was examined. The native potato starch (NPS) group was used as the negative group. RESULTS Ca2+CPSM had almost the same hemostatic efficacy compared with Arista; meanwhile, all the 4 hemostatic agents had good blood compatibility. In terms of in vivo tissue compatibility, Ca2+CPSM had relatively fast degradation and absorption rate with good histocompatibility. As the morphological, anatomic observation and H&E staining of liver defects after implantation, Ca2+CPSM was almost completely absorbed by liver tissue after 14 days. CONCLUSION According to our study, Ca2+CPSM could effectively achieve hemostasis in the standard rat liver injury model and exhibited good blood compatibility and in vivo tissue compatibility. These finding suggested that Ca2+CPSM as a new kind of APSH had its extensive clinical application value.
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Affiliation(s)
- Jianjun Zhu
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China.,96702State Key Laboratory of NBC Protection for Civilian, Beijing, PR China
| | - Zhuona Wu
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Wenzhong Sun
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Zhiyun Meng
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Xiaoxia Zhu
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Hui Gan
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Ruolan Gu
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
| | - Xuan Guo
- 96702State Key Laboratory of NBC Protection for Civilian, Beijing, PR China
| | - Guifang Dou
- Department of Pharmaceutical Sciences, 96702Beijing Institute of Radiation Medicine, Beijing, PR China
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Pacheco M, Barros AA, Aroso IM, Autorino R, Lima E, Silva JM, Reis RL. Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective. J Biomed Mater Res B Appl Biomater 2020; 108:3099-3123. [PMID: 32458570 DOI: 10.1002/jbm.b.34637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.
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Affiliation(s)
- Margarida Pacheco
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre A Barros
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ivo M Aroso
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Estêvão Lima
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Joana M Silva
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Lee DH, Ko W. Hemostatic materials in non-variceal upper gastrointestinal hemorrhage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Don Haeng Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
- Utah-Inha DDS and Advanced Therapeutics Research Center, Incheon, Korea
| | - Weonjin Ko
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Slezak P, Keibl C, Redl H, Labahn D, Gulle H. An Efficacy Comparison of Two Hemostatic Agents in a Porcine Liver Bleeding Model: Gelatin/Thrombin Flowable Matrix versus Collagen/Thrombin Powder. J INVEST SURG 2019; 33:828-838. [PMID: 30907197 DOI: 10.1080/08941939.2019.1571130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose: Management of bleeding during surgery can be aided by the application of topical hemostatic agents. This study compared the hemostatic efficacy of a new powder agent containing collagen, chondroitin sulfate, and thrombin (PCCT) with a flowable gelatin-thrombin matrix with smooth particles (SmGM) in a porcine liver bleeding model. Materials and Methods: Lesions 4-6 mm deep and ∼10 mm in diameter were created in porcine livers and treated with either SmGM or PCCT. Bleeding rate and grade were quantified before and 3, 7, and 11 minutes after treatment. Results: Thirty-two lesions each were treated with SmGM or PCCT; the median (Q1, Q3) initial bleeding rate was comparable between the two groups (8.43 [6.18, 10.68] g/min and 7.15 [5.16, 9.63] g/min, respectively). The residual bleeding rate was significantly lower at all time-points post treatment for SmGM compared with PCCT (3 minutes: 0.14 [0.07, 0.21] versus 0.46 [0.20, 1.20] g/min, p < 0.0001; 7 minutes: 0.07 [0.04, 0.11] versus 0.12 [0.08, 0.39] g/min, p = 0.001; 11 minutes: 0.05 [0.03, 0.08] versus 0.07 [0.05, 0.12] g/min, p = 0.043). Bleeding grade at 3 minutes was also significantly lower for SmGM compared with PCCT (median [Q1, Q3] 0.0 [0.0, 0.0] versus 1.0 [1.0, 2.0], p < 0.0001). PCCT required reapplication in approximately one-third of applications due to insufficient hemostasis 4 minutes after initial application and showed a tendency to stick to the wet gauze during approximation. Conclusions: In this bleeding model, treatment with SmGM resulted in reduced blood loss, no need for reapplication and was easier to apply compared with PCCT.
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Affiliation(s)
- Paul Slezak
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Vienna, Austria
| | - Dirk Labahn
- Baxter Medical Products GmbH, Vienna, Austria
| | - Heinz Gulle
- Baxter Medical Products GmbH, Vienna, Austria
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