Prospective, randomized, controlled, noninferiority clinical trial to evaluate the safety and efficacy of absorbable macroporous polysaccharide composites as adjunct to hemostasis during open surgery

Use of Ultra-Hydrophilic Absorbable Polysaccharide for Bleeding Control in Cardiothoracic Surgical Procedures

Background and Objectives: Operative blood loss is strongly correlated with morbidity and mortality in surgery. Various hemostatic agents are used to reduce bleeding in cardiothoracic procedures. We report our experience with a plant-based microporous polysaccharide hemostatic powder (Starsil® Hemostat, Hemostat Medical GmbH, Velen, Germany). Materials and Methods: Data were collected retrospectively from 65 patients who underwent cardiac surgery at our institution from January 2012 to January 2015 with (n = 42) or without (n = 23; control group) the use of the hemostat powder. Primary endpoints were safety (e.g., laboratory parameters, adverse events, and infection parameters) and time to hemostasis when the hemostat powder was used. Other endpoints included operation time, hospitalization, quantity of the hemostat powder applied, and length of stay in the intensive care unit. Results: The 65 patients (49 male:16 female) analyzed in the study underwent 65 cardiothoracic procedures, including off-pump coronary artery bypass grafts (n = 25), on-pump coronary artery bypass grafts (n = 6), valve procedures (n = 6), valve procedures in combination with bypass grafts (n = 7), and others (n = 21). The application of the hemostat powder did not increase adverse events. The laboratory parameters did not exceed the expected range after heart surgery in both groups. The hemostat powder had no significant impact on the laboratory parameters compared to the control group. Blood control was sufficient and was rated by surgeons from good to very good on a visual analog scale (VAS) from 1 (very bad) to 10 (very good) [VAS = 8.3 ± 1.2]. Intraoperative hemostasis was possible in nearly all patients. The hemostat powder led to satisfactory bleeding control within 2 min in 88% of cases. Five patients needed a second 5 g unit of the hemostat powder. Conclusions: The observed parameters between groups did not differ significantly. Therefore, the use of Starsil® Hemostat in cardiothoracic surgery is safe and effective bleeding control was achieved.