Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding

A comparative analysis of collagen based dressings and polysaccharide microspheres for hemostasis management in hepatic stab wounds

This study aims to evaluate two of the most commonly used products, the collagen-based patch (Hemopatch) and the micropolysaccharide microspheres powder (Perclot), in the context of stab liver injury in pigs. The objectives of this study were to assess blood loss at various time intervals up to 24 h, survival rates, and mean arterial pressure. The research involved 18 Large-White swine. The animals underwent a traumatic liver puncture through two 5 cm deep blade incisions that severed two main suprahepatic veins. Hemostatic surgical treatment was conducted for 12 min using two hemostatic agents. In the first 3 min after injury, the Hemopatch group lost less blood than the Perclot group, with 300 cc (222.5-415.0) compared to 555.0 cc (480.0-632.5) (p = 0.001). However, at 13-60 min post-injury, the Perclot group lost less blood than the Hemopatch group, 45.0 cc (32.5-135.0) compared to 305.0 cc (112.5-607.5) (p = 0.015). Lastly, the survival rate 24 h after injury was higher in the Perclot group (88.8%) compared to the Hemopatch group (44.4%) (p = 0.046). Several disparities were observed between Perclot and Hemopatch. Although Hemopatch demonstrates prompt bleeding reduction in the initial 3 min, Perclot is capable of stabilizing the clot and subsequently reducing long-term bleeding, ultimately increasing the likelihood of survival. These observations support the utilization of Perclot for managing severe hepatic hemorrhage.

Effectiveness of a thrombin-gelatin flowable for treating severe liver bleeding: an experimental study

BACKGROUND

Current scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model.

METHODS

Twenty-four swine were prospectively randomized to receive either Flowable or standard packing technique. We used a novel severe liver injury model, in which the middle and left suprahepatic veins were selectively injured, causing an exsanguinating hemorrhage. The main outcome measure was the percentage of lost blood volume.

RESULTS

The median total percentage of total blood volume per animal lost, from injury to minute 120, was significantly lower in the Flowable group (15.2%; interquartile range: 10.7-46.7%) than in the Packing group (64.9%; Interquartile range: 53.4-73.0%) (Hodges-Lehmann median difference: 41.1%; 95% CI: 18.9-58.0%, p = 0.0034). The 24-hour survival rate was significantly higher in the Flowable group (87.0%) than in the Packing group (0.0%) (Hazard ratio (HR) 0.08; 95% confidence interval 0.102 to 0.27; p < 0.0001). Mean-arterial pressure was significantly lower at minute 60 and 120 in the Flowable group than in the packing group (p = 0.0258 and p = 0.0272, respectively). At minute 120, hematocrit was higher in the Flowable than in the packing group (Hodges-Lehmann median difference: 5.5%; 95%CI: 1.0 to11.0, p = 0.0267). Finally, the overall-surgical-procedure was significantly shorter with Flowable than with Packing (Hodges-Lehmann median difference: 39.5 s, 95% CI: 25.0 to 54.0 s, p = 0.0004).

CONCLUSIONS

The use of the Flowable was more effective in achieving hemostasis, reducing blood loss, and improving survival rates than standard packing in a severe porcine-liver bleeding model.

Advances in Topical Hemostatic Agent Therapies: A Comprehensive Update

Severe hemorrhage causes significant metabolic and cellular dysfunction secondary to deficient tissue perfusion and oxygen delivery. If bleeding continues, hemodynamic destabilization, hypoxemia, multiple organ failure, and death will occur. Techniques employed to promote hemostasis include surgical suture ligatures, cautery, chemical agents, self-assembling nanoparticles, and physical methods, like mechanical pressure. Improved understanding of the natural clotting cascade has allowed newly designed agents to become more targeted for clinical and military use. Topically-applied hemostatic agents have enormous clinical applications in achieving hemostasis. This manuscript describes currently available and developing topical hemostatic materials, including topical active agents, mechanical agents, synthetic/hemisynthetic hemostatic agents, and external hemostatic dressings for clinical practice.