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Wachtel C, Rothenberger J, Ederer IA, Souquet J, Rieger U. Systemic Tranexamic Acid for Reduced Postoperative Blood Loss and Less Bleeding Complications in Fleur-de-lis Abdominoplasty and Apronectomy. Aesthetic Plast Surg 2024; 48:2465-2474. [PMID: 38548959 DOI: 10.1007/s00266-024-03992-5] [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: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Strategies minimizing surgical bleeding, including the antifibrinolytic agent tranexamic acid, play a crucial role in clinical practice to optimize overall surgical outcomes. Despite its proven efficacy in various clinical fields, there is a limited understanding regarding the use of tranexamic acid in plastic and aesthetic procedures. This study is the first investigating the effects of systemically administered tranexamic acid on postoperative blood loss and bleeding complications in fleur-de-lis abdominoplasties and apronectomies. METHODS Patients who received 1 g tranexamic acid (n = 44) during fleur-de-lis abdominoplasty or apronectomy were retrospectively compared with those who did not (n = 44). In this context, the outcome parameters 24-h and total drain fluid production, drain time, hospital stay, absolute and relative drop in hemoglobin and hematocrit level as well as bleeding complications such as blood transfusion, hematoma puncture and evacuation were evaluated. RESULTS Tranexamic acid significantly decreased both drainage volume in 24 h (40.5%, p = 0.0046) and total drain fluid production (42.5%, p = 0.0017). Moreover, a shorter drainage time (19.4%, p = 0.0028) and hospital stay (21.4%, p = 0.0009) were observed. The administration of tranexamic acid was also associated with a reduced postoperative decline in hemoglobin and hematocrit levels. Notably, no bleeding complications were observed in patients who received tranexamic acid, while 6 events occurred in patients without (p = 0.0262). CONCLUSION Systemic administration of tranexamic acid effectively reduced postoperative blood loss and bleeding complications in fleur-de-lis abdominoplasties and apronectomies. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Carolin Wachtel
- Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Germany.
| | - Jens Rothenberger
- Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Diakonie Hospital, Bad Kreuznach, Germany
| | - Ines Ana Ederer
- Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Germany
| | - Jochen Souquet
- Department of Anesthesiology und Pain Medicine, Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Ulrich Rieger
- Department of Plastic and Aesthetic Surgery, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Germany
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Lee J, Kim E, Kim KJ, Rhie JW, Joo KI, Cha HJ. Protective Topical Dual-Sided Nanofibrous Hemostatic Dressing Using Mussel and Silk Proteins with Multifunctionality of Hemostasis and Anti-Bacterial Infiltration. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2308833. [PMID: 38185768 DOI: 10.1002/smll.202308833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/18/2023] [Indexed: 01/09/2024]
Abstract
Topical hemostatic agents are preferred for application to sensitive bleeding sites because of their immediate locoregional effects with less tissue damage. However, the majority of commercial hemostatic agents fail to provide stable tissue adhesion to bleeding wounds or act as physical barriers against contaminants. Hence, it has become necessary to investigate biologically favorable materials that can be applied and left within the body post-surgery. In this study, a dual-sided nanofibrous dressing for topical hemostasis is electrospun using a combination of two protein materials: bioengineered mussel adhesive protein (MAP) and silk fibroin (SF). The wound-adhesive inner layer is fabricated using dihydroxyphenylalanine (DOPA)-containing MAP, which promotes blood clotting by aggregation of hemocytes and activation of platelets. The anti-adhesive outer layer is composed of alcohol-treated hydrophobic SF, which has excellent spinnability and mechanical strength for fabrication. Because both proteins are fully biodegradable in vivo and biocompatible, the dressing would be suitable to be left in the body. Through in vivo evaluation using a rat liver damage model, significantly reduced clotting time and blood loss are confirmed, successfully demonstrating that the proposed dual-sided nanofibrous dressing has the right properties and characteristics as a topical hemostatic agent having dual functionality of hemostasis and physical protection.
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Affiliation(s)
- Jaeyun Lee
- Department of Chemical Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, 37673, Republic of Korea
| | - Eunjin Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ki-Joo Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jong Won Rhie
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kye Il Joo
- Department of Chemical Engineering and Materials Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Hyung Joon Cha
- Department of Chemical Engineering, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, 37673, Republic of Korea
- Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, 77 Cheongam-ro, Nam-gu, Pohang, 37673, Republic of Korea
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Chen R, Du F, Yuan Q. Multifunctional Sodium Hyaluronate/Chitosan Foam Used as an Absorbable Hemostatic Material. Bioengineering (Basel) 2023; 10:868. [PMID: 37508894 PMCID: PMC10376295 DOI: 10.3390/bioengineering10070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Absorbable hemostatic materials have great potential in clinical hemostasis. However, their single coagulation mechanism, long degradation cycles, and limited functionality mean that they have restricted applications. Here, we prepared a sodium hyaluronate/carboxymethyl chitosan absorbable hemostatic foam (SHCF) by combining high-molecular-weight polysaccharide sodium hyaluronate with carboxymethyl chitosan via hydrogen bonding. SHCFs have rapid liquid absorption performance and can enrich blood cells. They transform into a gel when it they come into contact with blood, and are more easily degraded in this state. Meanwhile, SHCFs have multiple coagulation effects and promote hemostasis. In a rabbit liver bleeding model, SHCFs reduced the hemostatic time by 85% and blood loss by 80%. In three severe and complex bleeding models of porcine liver injury, uterine wall injury, and bone injury, bleeding was well-controlled and anti-tissue adhesion effects were observed. In addition, degradation metabolism studies show that SHCFs are 93% degraded within one day and almost completely metabolized within three weeks. The absorbable hemostatic foam developed in this study is multifunctional; with rapid hemostasis, anti-adhesion, and rapid degradation properties, it has great clinical potential for in vivo hemostasis.
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Affiliation(s)
- Ran Chen
- Laboratory of Biosynthesis and Efficient Separation of Natural Active Ingrediens, Beijing University of Chemical Technology, Beijing 100029, China
| | - Fanglin Du
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Qipeng Yuan
- Laboratory of Biosynthesis and Efficient Separation of Natural Active Ingrediens, Beijing University of Chemical Technology, Beijing 100029, China
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Eskildsen MPR, Kalliokoski O, Boennelycke M, Lundquist R, Settnes A, Loekkegaard E. An autologous blood-derived patch as a hemostatic agent: evidence from thromboelastography experiments and a porcine liver punch biopsy model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:20. [PMID: 37074487 PMCID: PMC10115690 DOI: 10.1007/s10856-023-06726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
Perioperative bleeding is a common complication in surgeries that increases morbidity, risk of mortality, and leads to increased socioeconomic costs. In this study we investigated a blood-derived autologous combined leukocyte, platelet, and fibrin patch as a new means of activating coagulation and maintaining hemostasis in a surgical setting. We evaluated the effects of an extract derived from the patch on the clotting of human blood in vitro, using thromboelastography (TEG). The autologous blood-derived patch activated hemostasis, seen as a reduced mean activation time compared to both non-activated controls, kaolin-activated samples, and fibrinogen/thrombin-patch-activated samples. The accelerated clotting was reproducible and did not compromise the quality or stability of the resulting blood clot. We also evaluated the patch in vivo in a porcine liver punch biopsy model. In this surgical model we saw 100% effective hemostasis and a significant reduction of the time-to-hemostasis, when compared to controls. These results were comparable to the hemostatic properties of a commercially available, xenogeneic fibrinogen/thrombin patch. Our findings suggest clinical potential for the autologous blood-derived patch as a hemostatic agent.
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Affiliation(s)
- Morten P R Eskildsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Experimental Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Otto Kalliokoski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Experimental Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Boennelycke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Annette Settnes
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Loekkegaard
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Biodegradable sponges based on starch, hyaluronic acid, and poly-l-lysine as potent hemostatic agents. Macromol Res 2023. [DOI: 10.1007/s13233-023-00135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Deng L, Wang L, Li L, Gong Z, Wang R, Fei W, Zhou Y, Wang F. Bioabsorbable Fibrillar Gauze Dressing Based on N-Carboxyethyl Chitosan Gelling Fibers for Fatal Hemorrhage Control. ACS APPLIED BIO MATERIALS 2023; 6:899-907. [PMID: 36691985 DOI: 10.1021/acsabm.2c01089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Death from lethal hemorrhage remains a major problem in various emergency scenarios. There is a continuous interest in the development of absorbable hemostatic dressings that can control hemorrhage rapidly and can be left in the wound site without removal. In this study, we report a hemostatic gauze dressing based on N-carboxyethyl chitosan (CECS) gelling fibers. The CECS fibrillar gauze combines ultra-hydrophilic, cationic chemical property of the fiber components with the fluffy nonwoven material form, exhibiting good conformability for wound filling, high fluid uptaking capacity, and enhanced blood-concentrating effect. In a swine femoral artery injury model, the CECS fibrillar gauze achieves shorter time to hemostasis and less blood loss compared with commercially available hemostatic dressings. This chitosan gelling fiber gauze demonstrates comparable bioabsorbability to clinically used absorbable hemostat and thus may be applied to treat fatal hemorrhage both in emergency medical services and in internal surgical procedures.
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Affiliation(s)
- Lili Deng
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Liu Wang
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Li Li
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Zuguang Gong
- College of Materials Science and Engineering and Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, China
| | - Ruilan Wang
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Wendi Fei
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Yingshan Zhou
- College of Materials Science and Engineering and Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, China
| | - Fang Wang
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
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Altintaş T, Önalan NBD, Kızılkaya MC, Gündüz N, Bozkurt MA. Effect of hyperthermic chemotherapy on topical hemostatic agents. Acta Chir Belg 2022; 122:164-168. [PMID: 33635752 DOI: 10.1080/00015458.2021.1888199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE There is no clear consensus as to which topical hemostatic agent is best used during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. The aim of this study was to evaluate the effect of hyperthermic chemotherapy on the biomechanical properties of organic topical hemostatic agents and histologically fibrin formation rates. METHODS Four topical hemostatic agents (Spongostan™, Surgicel®, Fibrillar™, Arista®) were evaluated. All agents were mixed with 3 ml blood in sterile tubes separately to form clot formation. The resulting clot formations were incubated with 36 °C and 42 °C with saline or cisplatin for 1 h. Strength and flexibility of hemostatic samples were evaluated under weight of 0 g, 50 g, 100 g, 200 g and 300 g. All samples were stained with hemotoxylin-eosin and compared histologically for fibrin clot formation under light microscope. RESULTS There were no statistically significant differences according to strength and flexibility of topical hemostatic agents on hyperthermic chemotherapy. Histopathologically, the highest fibrin formation was observed in Surgicel®, followed by Fibrillar™. The least fibrin formation was detected in Arista®. CONCLUSIONS This study demonstrated that exposure to hyperthermic chemotherapy did not significantly affect the biomechanical properties of organic topical hemostatic agents and the fibrin clot formation.
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Affiliation(s)
- Tansu Altintaş
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - N. Berrin Dodur Önalan
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Celal Kızılkaya
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nermin Gündüz
- Department of Pathology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Bagheri SM, Ghadamzadeh M, Chavoshi M. Percutaneous embolization of renal pseudoaneurysms: A retrospective study. Indian J Urol 2022; 38:296-301. [PMID: 36568457 PMCID: PMC9787449 DOI: 10.4103/iju.iju_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction We evaluated the efficacy of the mixture of autologous blood and a hemostatic agent, oxidized regenerative cellulose (ORC), as an alternative material for ultrasound (US)-guided percutaneous embolization of renal pseudoaneurysm (PA). Methods In this retrospective study, consecutive patients diagnosed with renal PA were included. The exclusion criteria were: PA of the main renal artery, tiny PA not visualized on the colour doppler ultrasonography, PA more than 3 cm in max diameter or extracapsular PA with the possibility of massive bleeding, and patients with a history of coagulation disorders. After localizing the PA, a mixture of autologous blood and ORC was injected under US guidance with a 15G coaxial needle. Patients were followed up for at least 6 months. Results Twenty-nine patients with PA were included, of which 26 had a history of percutaneous nephrolithotomy, and three patients had a history of renal biopsy (24 men and five women with an average age of 44.3 years). Gross hematuria was the most common mode of presentation. The mean size of the PA was 16.6 mm and the mean duration of follow-up was 9 months. The clinical and the technical success rate was 100%. The PA could be thrombosed in all the patients with a single-session of injection. No acute (hematoma, infection, and bleeding) or chronic (thromboembolic events, renal cortical atrophy, and recurrence) complications were seen. Conclusion Percutaneous embolization of renal PA under US guidance with a mixture of autologous blood and ORC is an efficient and easily available first-line method to treat this potentially life-threatening condition when endovascular embolization or other expensive thrombotic agents are not available.
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Affiliation(s)
- Seyed Morteza Bagheri
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghadamzadeh
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,
E-mail:
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Cziperle DJ. Avitene™ Microfibrillar Collagen Hemostat for Adjunctive Hemostasis in Surgical Procedures: A Systematic Literature Review. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:155-163. [PMID: 34104007 PMCID: PMC8179802 DOI: 10.2147/mder.s298207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Adequate hemostasis during surgical procedures is essential for successful patient outcomes and reduced healthcare resource utilization. Topical hemostatic agents can act as catalysts for the clotting cascade or as a scaffold to promote platelet activation or aggregation. Although an ever-increasing number of topical absorbable hemostatic agents are now available for perioperative use, health care providers are disadvantaged by the lack of comparative data on feasibility, clinical effectiveness, advantages, and limitations of each in specific surgical settings. This knowledge is important for appropriate product choice when patient characteristics, type of surgical procedure, type of bleeding, and product availability may differ widely. This manuscript provides the first comprehensive overview of Avitene™ Microfibrillar Collagen Hemostat (MCH), a bovine collagen-based absorbable hemostat that has been widely used for over four decades in the United States and abroad. MCH is indicated as an adjunct to hemostasis across a broad spectrum of surgical specialties and has been shown to achieve hemostasis with positive patient outcomes and a favorable safety profile in many applications, including hepatic, orthopedic, splenic, oral, and otolaryngologic surgery. Although published clinical data regarding the use of MCH in cardiovascular surgery is limited, evidence suggests moderate use in this specialty. The information contained in this systematic review will help health care providers understand the clinical use and effectiveness of the product to determine appropriate use in differing bleeding scenarios across multiple surgical specialties. Future studies may include comparative functional and cost analyses to explore the economic advantages of using absorbable hemostatic agents compared with each other or with conventional techniques of hemostasis, when appropriate.
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Affiliation(s)
- David J Cziperle
- Thoracic Surgery, Ann B. Barshinger Cancer Institute, Lancaster, PA, USA
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Ramey D, Mudge M, Rudolphi O, Waxman S. Use of an absorbable haemostatic gauze product to control bleeding in 20 horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D. Ramey
- Ramey Equine Chatsworth CaliforniaUSA
| | - M. Mudge
- Department of Veterinary Clinical Sciences The Ohio State University Columbus OhioUSA
| | - O. Rudolphi
- Rudolphi Veterinary Services, Ltd. Noble IllinoisUSA
| | - S. Waxman
- Department of Veterinary Clinical Sciences Purdue University College of Veterinary Medicine West Lafayette Indiana USA
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Elena Scarafoni E. A Systematic Review of Tranexamic Acid in Plastic Surgery: What's New? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3172. [PMID: 33907653 PMCID: PMC8062149 DOI: 10.1097/gox.0000000000003172] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures. METHODS A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery. RESULTS A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis. CONCLUSIONS The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.
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Affiliation(s)
- Esteban Elena Scarafoni
- From the Department of Plastic and Reconstructive Surgery, Hospital de Quemados, Buenos Aires, Argentina
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Malik A, Rehman FU, Shah KU, Naz SS, Qaisar S. Hemostatic strategies for uncontrolled bleeding: A comprehensive update. J Biomed Mater Res B Appl Biomater 2021; 109:1465-1477. [PMID: 33511753 DOI: 10.1002/jbm.b.34806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
Uncontrolled bleeding remains the leading cause of morbidity and mortality across the entire macrocosm. It refers to excessive loss of blood that occurs inside of body, due to unsuccessful platelet plug formation at the injury site. It is not only limited to the battlefield, but remains the second leading cause of death amongst the civilians, as a result of traumatic injury. Startlingly, there are no effective treatments currently available, to cater the issue of internal bleeding, even though early intervention is of utmost significance in minimizing the mortality rates associated with it. The fatal issue of uncontrolled bleeding is ineffectively being dealt with the use of pressure dressings, tourniquet, and surgical procedures. This is not a practical approach in combat arenas or in emergency situations, where the traumatic injury inflicted is deep inside the body, and cannot be addressed externally, by the application of topical dressings. This review focuses on the traditional hemostatic agents that are used to augment the process of hemostasis, such as mineral zeolites, chitosan based products, biologically active agents, anti-fibrinolytics, absorbable agents, and albumin and glutaraldehyde, as well as the micro- and nano-based hemostatic agents such as synthocytes, thromboerythrocytes, thrombosomes, and the synthetic platelets.
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Affiliation(s)
- Annum Malik
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Fiza Ur Rehman
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Syeda Sohaila Naz
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
| | - Sara Qaisar
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
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A comprehensive review of topical hemostatic agents: The good, the bad, and the novel. J Trauma Acute Care Surg 2020; 88:e1-e21. [PMID: 31626024 DOI: 10.1097/ta.0000000000002508] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Uncontrolled exsanguination remains the leading cause of death for trauma patients, many of whom die in the pre-hospital setting. Without expedient intervention, trauma-associated hemorrhage induces a host of systemic responses and acute coagulopathy of trauma. For this reason, health care providers and prehospital personal face the challenge of swift and effective hemorrhage control. The utilization of adjuncts to facilitate hemostasis was first recorded in 1886. Commercially available products haves since expanded to include topical hemostats, surgical sealants, and adhesives. The ideal product balances efficacy, with safety practicality and cost-effectiveness. This review of hemostasis provides a guide for successful implementation and simultaneously highlights future opportunities.
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Topical hemostatic and tissue-sealing agents in gynecologic surgery. Curr Opin Obstet Gynecol 2020; 32:285-291. [PMID: 32324712 DOI: 10.1097/gco.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To review current topical hemostatic agent use and how it pertains to gynecologic surgery. RECENT FINDINGS Recent literature suggests some benefit of topical hemostatic agents (THA). THAs confer reduced bleeding and shorter operating room time in women undergoing hysterectomy for cancer and in abdominal myomectomy. THA use in women undergoing ovarian cystectomy is associated with a decreased reduction in ovarian reserve. Potential complications of THA use include abscess formation, small bowel obstruction, inflammation, allergic reaction, and transmission of blood-borne pathogens. Evidence for use of THA in benign minimally invasive gynecologic surgery (MIGS) procedures is lacking. SUMMARY Although evidence exists for the efficacy of THA in reducing blood loss and operating times across surgical subspecialties, specific, appropriate, and efficacious use of THAs in gynecologic surgery remains ill-defined. Knowledge of their mechanisms of action and potential complications should enable surgeons to optimize desired effects and minimize harm.
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Merocel Surgicel Wrap Technique to Manage Diffuse Epistaxis in Patients with Comorbidities. Int J Otolaryngol 2020; 2020:8272914. [PMID: 32280348 PMCID: PMC7125479 DOI: 10.1155/2020/8272914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
Epistaxis, or nasal bleeding, occurs in over half of the general population. It is caused by various etiological factors and affects both sexes and all age groups. The simplest treatment for a nosebleed is pinching of the ala nasi, referred to as the Hippocratic technique. In this study, we adopted different treatment protocols dependent on the severity of bleeding and assessed the etiology and efficacy of these modalities. This was a prospective study. We recruited 25 patients (24 adults and 1 child) who presented with epistaxis in the ENT departments of two tertiary care hospitals. We evaluated the cause of epistaxis and efficacy of the treatments used. All patients had experienced several episodes of epistaxis and were managed using anterior nasal packing with gauze and ointment or with Merocel packs alone. The incidence of epistaxis was more common in males than in females. It was effectively managed by anterior nasal packing with Surgicel-wrapped Merocel. Patients did not experience further episodes of bleeding following the removal of Merocel and retention of Surgicel in place.
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Chen Y, Wu L, Li P, Hao X, Yang X, Xi G, Liu W, Feng Y, He H, Shi C. Polysaccharide Based Hemostatic Strategy for Ultrarapid Hemostasis. Macromol Biosci 2020; 20:e1900370. [DOI: 10.1002/mabi.201900370] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Yeyi Chen
- School of Chemical Engineering and TechnologyTianjin University Tianjin 300350 China
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
| | - Lei Wu
- School of Chemical Engineering and TechnologyTianjin University Tianjin 300350 China
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
| | - Pengpeng Li
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
- School of Ophthalmology & OptometryEye HospitalSchool of Biomedical EngineeringWenzhou Medical University Wenzhou Zhejiang 325027 China
| | - Xiao Hao
- Cardiovascular Division 1Hebei General Hospital Shijiazhuang Hebei 050051 China
| | - Xiao Yang
- School of Chemical Engineering and TechnologyTianjin University Tianjin 300350 China
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
| | - Guanghui Xi
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
| | - Wen Liu
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
| | - Yakai Feng
- School of Chemical Engineering and TechnologyTianjin University Tianjin 300350 China
| | - Hongchao He
- Department of UrologyShanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200025 China
| | - Changcan Shi
- Wenzhou Institute of Biomaterials and EngineeringWenzhou InstituteUniversity of Chinese Academy of Sciences Wenzhou Zhejiang 325011 China
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Abstract
Since a variety of procoagulant products, collectively called hemostatic agents, became available to surgeons in the mid-20th century, their use has increased across multiple specialties, including gynecology. Congruent with past research on the causes of regional variation in the practice of medicine, available evidence suggests that a central predictor for use of these products is physician preference rather than documented clinical necessity. Use of these products adds risks and avoidable cost. This article seeks to highlight specific gynecologic circumstances in which evidence and surgical judgment supports hemostatic agent use and other settings in which use should be reconsidered.
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Chen X, Li S, Yan Y, Su J, Wang D, Zhao J, Wang S, Zhang X. Absorbable nanocomposites composed of mesoporous bioglass nanoparticles and polyelectrolyte complexes for surgical hemorrhage control. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 109:110556. [PMID: 32228979 DOI: 10.1016/j.msec.2019.110556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/04/2019] [Accepted: 12/12/2019] [Indexed: 01/24/2023]
Abstract
Absorbable polyelectrolyte complexes-based hemostats are promising for controlling hemorrhage in iatrogenic injuries during surgery, whereas their hemostatic efficacy and other performances require further improvement for clinical application. Herein, spherical mesoporous bioglass nanoparticles (mBGN) were fabricated, and mBGN-polyelectrolyte complexes (composed of carboxymethyl starch and chitosan oligosaccharide) nanocomposites (BGN/PEC) with different mBGN contents were prepared via in situ coprecipitation followed by lyophilization. The effect of various mBGN content (10 and 20 wt%) on morphology, zeta potential, water absorption, degradation behavior and ion release were systematically evaluated. The in vitro degradability was dramatically promoted and a more neutral environment was achieved with the incorporation of mBGN, which is preferable for surgical applications. The in vitro coagulation test with whole blood demonstrated that the incorporation of mBGN facilitated blood clotting process. The plasma coagulation evaluation indicated that BGN/PEC had increased capability to accelerate coagulation cascade via the intrinsic pathway than that of the PEC, while have inapparent influence on the extrinsic and common pathway. The in vivo hemostatic evaluation in a rabbit hepatic hemorrhage model revealed that BGN/PEC with 10 wt% mBGN (10BGN/PEC) treatment group had the lowest blood loss, although its hemostatic time is close to that of 20BGN/PEC treatment group. The cytocompatibility evaluation with MC3T3-L1 fibroblasts indicated that 10BGN/PEC induced a ~25% increase of cell viability compared to the PEC at days 4 and 7, indicating improved biocompatibility. These findings support the promising application of absorbable BGN/PEC with optimized mBGN content as internal hemostats and present a platform for further development of PEC-based hemostats.
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Affiliation(s)
- Xingtao Chen
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Shuyang Li
- College of Physical Science and Technology, Sichuan University, Chengdu 610064, China
| | - Yonggang Yan
- College of Physical Science and Technology, Sichuan University, Chengdu 610064, China.
| | - Jiacan Su
- Department of Orthopaedics Trauma, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
| | - Dongliang Wang
- Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Dept Orthoped Surg, 1665 Kongjiang Rd, Shanghai 200092, PR China
| | - Jun Zhao
- Shanghai Jiao Tong Univ, Shanghai Peoples Hosp, 9, Dept Orthodont, Sch Med, Shanghai, China
| | - Sicheng Wang
- Department of Orthopaedics, Zhongye Hospital, Shanghai 200941, China
| | - Xin Zhang
- Department of Orthopaedics, Zhongye Hospital, Shanghai 200941, China
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Chen X, Yan Y, Li H, Wang X, Tang S, Li Q, Wei J, Su J. Evaluation of absorbable hemostatic agents of polyelectrolyte complexes using carboxymethyl starch and chitosan oligosaccharide both in vitro and in vivo. Biomater Sci 2018; 6:3332-3344. [PMID: 30357165 DOI: 10.1039/c8bm00628h] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CMS/COS PECs with a suitable COS content were promising absorbable hemostatic agents for internal use.
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Affiliation(s)
- Xingtao Chen
- College of Physical Science and Technology
- Sichuan University
- Chengdu 610064
- China
| | - Yonggang Yan
- College of Physical Science and Technology
- Sichuan University
- Chengdu 610064
- China
| | - Hong Li
- College of Physical Science and Technology
- Sichuan University
- Chengdu 610064
- China
| | - Xuehong Wang
- Key Laboratory for Ultrafine Materials of Ministry of Education
- East China University of Science and Technology
- 200237 Shanghai
- China
| | - Songchao Tang
- Key Laboratory for Ultrafine Materials of Ministry of Education
- East China University of Science and Technology
- 200237 Shanghai
- China
| | - Quan Li
- Department of Orthopaedics Trauma
- Changhai Hospital
- Second Military Medical University
- Shanghai 200433
- China
| | - Jie Wei
- Key Laboratory for Ultrafine Materials of Ministry of Education
- East China University of Science and Technology
- 200237 Shanghai
- China
| | - Jiacan Su
- Department of Orthopaedics Trauma
- Changhai Hospital
- Second Military Medical University
- Shanghai 200433
- China
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Cassano R, Di Gioia ML, Mellace S, Picci N, Trombino S. Hemostatic gauze based on chitosan and hydroquinone: preparation, characterization and blood coagulation evaluation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:190. [PMID: 29116465 DOI: 10.1007/s10856-017-6000-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/25/2017] [Indexed: 05/05/2023]
Abstract
This work concerns on the preparation and performance evaluation of a new chitosan hydroquinone based gauze for hemostatic use. Chitosan and hydroquinone were firstly connected by etherification and then linked to the pre-carboxylate gauze. The functionalized material and the chitosan-hydroquinone ether were characterized by Fourier Transform Infrared (FT-IR) Spectroscopy and Differential Scanning Calorimetry (DSC). FT-IR results showed that an esterification occurred on carboxylic group of the gauze. The gauze functionalization degree was also evaluated by volumetric analysis. The ether hydroquinone content was obtained by the Folin test. Moreover, the linkage between hydroquinone and chitosan was confirmed by nuclear magnetic resonance (NMR). The hemostatic activity of functionalized gauze was evaluated by dynamic blood clotting assays. The obtained results showed that the prepared material can shorten the blood clotting time and induce the adhesion and activation of platelets. Finally, swelling characteristic of the new gauze was evaluated to confirm its high capacity to absorb the blood.
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Affiliation(s)
- Roberta Cassano
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, 87036, Italy.
| | - Maria Luisa Di Gioia
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, 87036, Italy
| | - Silvia Mellace
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, 87036, Italy
| | - Nevio Picci
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, 87036, Italy
| | - Sonia Trombino
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Arcavacata di Rende, Cosenza, 87036, Italy
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Baumgartner B, Draxler W, Lewis KM. Treatment of Severe Aortic Bleeding Using Hemopatch in Swine on Dual Antiplatelet Therapy. J INVEST SURG 2016; 29:343-351. [DOI: 10.3109/08941939.2016.1154627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bernhard Baumgartner
- Department of Life Sciences & Operations, Baxter Healthcare Corporation, Deerfield, Ilinois, USA
| | - Wolfgang Draxler
- Department of Life Sciences & Operations, Baxter Healthcare Corporation, Deerfield, Ilinois, USA
| | - Kevin M. Lewis
- Department of Life Sciences & Operations, Baxter Healthcare Corporation, Deerfield, Ilinois, USA
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Lewis KM, Kuntze CE, Gulle H. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat). MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 9:1-10. [PMID: 26730213 PMCID: PMC4694675 DOI: 10.2147/mder.s90591] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat) is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG). NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies.
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Affiliation(s)
- Kevin Michael Lewis
- Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA
| | | | - Heinz Gulle
- Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria
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23
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Abstract
Introduction Massive hemorrhage remains a major cause of potentially preventable deaths. Better control of bleeding could improve survival rates by 10%–20%. Transfusion intervention concepts have been formulated in order to minimize acute traumatic coagulopathy. These interventions still have not been standardized and vary among medical centers. Materials and Methods Based on a literature search using free term keywords and Medical Subject Heading (MeSH) index, we analyzed published articles addressing massive hemorrhage, component therapy, fresh whole blood, and fibrinogen from the year 2000 onward, in journals with impact factor >1.000, in Medline, PubMed, and Google Scholar. The evidence was grouped into topics including laboratory testing and transfusion interventions/viscoelastic assays vs standard laboratory tests, the effect of component therapy on patient outcome, the effect of warm fresh whole blood on patient outcome, and the effects of fibrinogen in severe bleeding. The obtained information was compared, evaluated, confronted, and was focused on to present an adequate and individual-based massive hemorrhage management approach. Results Viscoelastic whole-blood assays are superior to standard coagulation blood tests for the identification of coagulopathy and for guiding decisions on appropriate therapy in patients with severe bleeding. Replacement of plasma, red blood cells, platelets, and fibrinogen in a ratio of 1:1:1:1 has appeared to be the best substitution for lost whole blood. There is no evidence that cryoprecipitate improves the outcome of patients with severe hemorrhage. Current literature promotes the transfusion of warm fresh whole blood, which seems to be superior to the component therapy in certain clinical situations. Some authors recommend that fibrinogen and other coagulation factors be administered according to the viscoelastic attributes of the blood clot. Conclusion This best-evidence topic report brings comprehensive information about massive hemorrhage management.
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Affiliation(s)
- Tomas Vymazal
- Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine Charles University, University Hospital Motol, Prague, Czech Republic
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Corral M, Ferko N, Hollmann S, Broder MS, Chang E. Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:409-21. [PMID: 26229495 PMCID: PMC4516034 DOI: 10.2147/ceor.s86369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Bleeding remains a common occurrence in surgery. Data describing the burden of difficult-to-control bleeding and topical absorbable hemostat use are sparse. This study was conducted to estimate the clinical and economic impact that remains associated with uncontrolled surgical bleeding, even when hemostats are used during surgery. Methods This US retrospective analysis used the Premier Perspectives Database. Hospital discharges from 2012 were used to identify patients treated with hemostats during eight surgery types. Patients were included if they were ≥18 years, had an inpatient hospitalization with one of the eight surgeries, and received a hemostat on the day of surgery. Patients were stratified by procedure and presence or absence of major bleeding (uncontrolled) despite hemostat use. Outcomes were all-cause hospitalization costs, hemostat costs, length of stay, reoperation, and surgery-related complications (eg, mortality). Statistical significance was tested through chi-square or t-tests. Multivariate analyses were conducted for all-cause costs and length of stay using analysis of covariance. Results Among 25,048 procedures, major bleeding events occurred in 14,251 cases. Despite treatment with hemostats, major bleeding occurred in 32%–68% of cases. All-cause costs were significantly higher in patients with uncontrolled bleeding despite hemostat use versus controlled bleeding (US$24,203–$61,323 [uncontrolled], US$14,420–$45,593 [controlled]; P<0.001). Hemostat costs were significantly greater in the uncontrolled bleeding cohort for all surgery types except cystectomy and pancreatic surgery. Reoperation and mortality rates were significantly higher in the uncontrolled bleeding cohort in all surgical procedures except cystectomy and radical hysterectomy. Conclusion Uncontrolled intraoperative bleeding despite hemostat use is prevalent and associated with significantly higher hospital costs and worse clinical outcomes across several surgical procedures compared to controlled bleeding. There is an unmet need for newer hemostats that can more effectively control bleeding, improve outcomes, and reduce hospital resource use.
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Affiliation(s)
| | - Nicole Ferko
- Cornerstone Research Group, Burlington, ON, Canada
| | | | - Michael S Broder
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
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Safety and Hemostatic Effectiveness of the Fibrin Pad for Severe Soft-Tissue Bleeding During Abdominal, Retroperitoneal, Pelvic, and Thoracic (Non-cardiac) Surgery: A Randomized, Controlled, Superiority Trial. World J Surg 2015; 39:2663-9. [DOI: 10.1007/s00268-015-3106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhuang B, Li Z, Pang J, Li W, Huang P, Wang J, Zhou Y, Lin Q, Zhou Q, Ye X, Ye H, Liu Y, Zhang LM, Chen R. Nanocomplexation of thrombin with cationic amylose derivative for improved stability and hemostatic efficacy. Int J Nanomedicine 2015; 10:939-47. [PMID: 25673989 PMCID: PMC4321601 DOI: 10.2147/ijn.s72553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
As a topical hemostatic agent, thrombin has wide application for many surgical treatments. However, native thrombin always suffers from its physical and chemical instabilities. In this work, a nanocomplexation strategy was developed for modifying the stability and hemostatic efficacy of thrombin, in which a water-soluble cationic amylose derivative containing poly(l-lysine) dendrons was prepared by a click reaction and then used to complex thrombin in an aqueous system. For resultant thrombin nanocomplexes, their morphology and particle size distribution were investigated. Their stabilities were studied in terms of activity retention percentages under different storage time, pH values, and illumination time. In addition, their ability to achieve in vitro fibrinogen and blood coagulation were evaluated. Via a rat hepatic hemorrhage model and a rat iliac artery hemorrhage model, these thrombin nanocomplexes were confirmed to have good tissue biocompatibility and in vivo hemostatic effectiveness.
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Affiliation(s)
- Baoxiong Zhuang
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhihua Li
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiadong Pang
- DSAPM Lab and PCFM Lab, Institute of Polymer Science, Department of Polymer and Materials Science, School of Chemistry and Chemical Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenbin Li
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Pinbo Huang
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jie Wang
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu Zhou
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qing Lin
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Quanbo Zhou
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiao Ye
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huilin Ye
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yimin Liu
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-Ming Zhang
- DSAPM Lab and PCFM Lab, Institute of Polymer Science, Department of Polymer and Materials Science, School of Chemistry and Chemical Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rufu Chen
- Department of Hepato-Pancreato-Billiary Surgery, Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
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Fatal intraoperative cardiac arrest after application of surgifoam into a bleeding iliac screw defect. Spine (Phila Pa 1976) 2014; 39:E1239-42. [PMID: 25010101 DOI: 10.1097/brs.0000000000000513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe the presentation, management, and autopsy findings in a case of a fatal intraoperative cardiac arrest after application of an absorbable hemostatic agent into a bleeding iliac bone screw defect. SUMMARY OF BACKGROUND DATA To the authors' knowledge, this represents the first reported complication of intraoperative death associated with Surgifoam (Ethicon) thromboembolization to the heart and lung microcirculation after its application into a bleeding bone defect. METHODS A 56-year-old male was undergoing revision fusion surgery for pseudarthrosis after multilevel thoracolumbosacral fusion with pelvic fixation for degenerative scoliosis. Intraoperatively, upon removal of the right iliac screw, heavy venous bleeding was encountered, which was stopped after application of 10 mL of Surgifoam into the screw defect. Approximately 5 minutes later, the patient's end tidal CO2 dropped, and his pulse was lost. Epinephrine was administered and the patient was immediately turned to supine position and cardiopulmonary resuscitation initiated. Cardiopulmonary resuscitation was performed unsuccessfully for 30 minutes at the end of which the patient was pronounced dead. RESULTS Autopsy findings revealed angulated particles of hemostatic agent with entrapped red blood cells partially to completely occluding small-to-medium-sized vessels of the heart and lungs. The cause of death was pulmonary and cardiac embolization of foreign material from the surgical screw defect to the vessels of the heart and lungs, significantly compromising respiration and blood flow causing sudden death. CONCLUSION Although Surgifoam is an excellent hemostatic agent for use in spinal surgery, it must be used with extreme caution in the setting of heavily bleeding bone defects after pedicle cannulation or removal of instrumentation. In cases when brisk venous bleeding is encountered, signifying potential compromise of an emissary vein, use of other hemostatic agents such as bone wax may be a safer option. LEVEL OF EVIDENCE N/A.
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Howe N, Cherpelis B. Obtaining rapid and effective hemostasis. J Am Acad Dermatol 2013; 69:659.e1-659.e17. [DOI: 10.1016/j.jaad.2013.07.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022]
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Fischer CP, Bochicchio G, Shen J, Patel B, Batiller J, Hart JC. A Prospective, Randomized, Controlled Trial of the Efficacy and Safety of Fibrin Pad as an Adjunct to Control Soft Tissue Bleeding During Abdominal, Retroperitoneal, Pelvic, and Thoracic Surgery. J Am Coll Surg 2013; 217:385-93. [DOI: 10.1016/j.jamcollsurg.2013.02.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 01/03/2023]
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Koea JB, Batiller J, Patel B, Shen J, Hammond J, Hart J, Fischer C, Garden OJ. A phase III, randomized, controlled, superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery. HPB (Oxford) 2013; 15:61-70. [PMID: 23216780 PMCID: PMC3533713 DOI: 10.1111/j.1477-2574.2012.00583.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/30/2012] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Haemostasis after liver resection may be difficult to achieve as a result of the presence of challenging bleeding, the anatomic landscape of the liver and the quality of tissue making up the hepatic parenchyma. The fibrin pad (FP) is a topical absorbable haemostat designed to be effective in a variety of tissues and across multiple bleeding intensities. This is the first clinical trial to evaluate the hemostat's safety and effectiveness in controlling bleeding during elective hepatic resection. METHODS This prospective, randomized, controlled superiority trial enrolled 104 subjects undergoing elective hepatectomy in 5 countries. After parenchymal transection, subjects with an appropriately defined target bleeding site (TBS) were stratified according to the type of hepatic parenchyma and immediately randomized 1:1: FP versus Standard of Care (SoC). SoC comprised manual compression with the use of an approved topical absorbable haemostat. The primary endpoint was haemostasis at 4 min from identification of the TBS, with no re-bleeding requiring re-treatment prior to abdominal closure. Results were stratified for both normal and abnormal (steatosis or cirrhosis) hepatic parenchyma. All subjects were followed for 60 days post-operatively. RESULTS The intent-to-treat (ITT) analysis showed an overall treatment difference of 53.0% (P < 0.001), 82.5% (33/40 FP) versus 29.5% (13/44 SoC) in achieving haemostasis at 4 min with no re-bleeding requiring treatment up to wound closure. The per protocol analysis showed an overall treatment difference of 65.7% (P < 0.001), with 33/35 successes (94.3%) in the FP group and 12/42 in the SoC group (28.6%). The stratification results showed treatment differences between the normal parenchyma group, 63.6% (95.8% FP versus 32.3% SoC P < 0.001) and a larger difference of 72.7% in the abnormal parenchyma group (90.9% FP versus 18.2% SoC P = 0.0003). Post-operative intra-abdominal fluid collections were less frequent in the FP group (3.4% FP versus 13.3% SoC P = 0.059). There was no difference in the safety profile between the FP or SoC groups. CONCLUSIONS The FP is safe and effective when used as an adjunct to achieve haemostasis during hepatic surgery. The success rate of achieving haemostasis with a FP remained high compared with the SOC group, especially in steatotic or cirrhotic liver tissue where the control success rates diminish. In addition, FP treatment of hepatic parenchymal surfaces may reduce the risk of post-operative biliary and fluid collections.
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Affiliation(s)
- Jonathan B Koea
- The Department of Surgery, Auckland City Hospital, New Zealand.
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31
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Abstract
Intraoperative complications of neck surgery are uncommon and rarely life-threatening and exact anatomical knowledge and precise dissection are most important for prevention. Anatomical variants (e.g. non-recurrent nerve, extralaryngeal branching) predispose to damage of the recurrent laryngeal nerve. The use of intraoperative neuromonitoring (IONM) can prevent bilateral nerve damage but in cases of accidental nerve damage primary reconstruction can improve vocal cord function. Autotransplantation of parathyroid tissue can reduce the rate of hypoparathyroidism but cannot be postulated as a routine measure. Intraoperative bleeding can usually be well controlled and greater danger for the patient emanates from early postoperative bleeding for which many techniques (clip, ligature, vessel sealing) can be employed for prevention. Lesions of the thoracic duct can be controlled by clip, ligation or stitch. Smaller lesions of the trachea and esophagus can be secured with direct suture or muscle flap plasty. In cases of larger lesions plastic reconstruction or organ replacement can be necessary.
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32
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Ipema HJ, Tanzi MG. Use of Topical Tranexamic Acid or Aminocaproic Acid to Prevent Bleeding After Major Surgical Procedures. Ann Pharmacother 2012; 46:97-107. [DOI: 10.1345/aph.1q383] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To evaluate the literature describing topical use of tranexamic acid or aminocaproic acid for prevention of postoperative bleeding after major surgical procedures. DATA SOURCES: Literature was retrieved through MEDLINE (1946-September 2011) and International Pharmaceutical Abstracts(1970-September 2011) using the terms tranexamic acid, aminocaproic acid, antifibrinolytic, topical, and surgical. In addition, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All identified articles in English were evaluated. Clinical trials, case reports, and meta-analyses describing topical use of tranexamic acid or aminocaproic acid to prevent postoperative bleeding were included. DATA SYNTHESIS: A total of 16 publications in the setting of major surgical procedures were included; the majority of data were for tranexamic acid. For cardiac surgery, 4 trials used solutions containing tranexamic acid (1-2.5 g in 100-250 mL of 0.9% NaCl), and 1 trial assessed a solution containing aminocaproic acid (24 g in 250 mL of 0.9% NaCl). These solutions were poured into the chest cavity before sternotomy closure. For orthopedic procedures, all of the data were for topical irrigation solutions containing tranexamic acid (500 mg-3 g in 50-100 mL of 0.9% NaCl) or for intraarticular injections of tranexamic acid (250 mg to 2 g in 20-50 mL of 0.9% sodium chloride, with or without carbazochrome sodium sulfate). Overall, use of topical tranexamic acid or aminocaproic acid reduced postoperative blood loss; however, few studies reported a significant reduction in the number of packed red blood cell transfusions or units given, intensive care unit stay, or length of hospitalization. CONCLUSIONS: Topical application of tranexamic acid and aminocaproic acid to decrease postsurgical bleeding after major surgical procedures is a promising strategy. Further data are needed regarding the safety of this hemostatic approach.
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Affiliation(s)
- Heather J Ipema
- Heather J Ipema PharmD BCPS, Clinical Assistant Professor, Drug Information Group, University of Illinois at Chicago
| | - Maria G Tanzi
- Maria G Tanzi PharmD, Clinical Assistant Professor, Drug Information Group, University of Illinois at Chicago
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Singleton RH, Jankowitz BT, Wecht DA, Gardner PA. Iatrogenic cerebral venous sinus occlusion with flowable topical hemostatic matrix. J Neurosurg 2011; 115:576-83. [DOI: 10.3171/2011.3.jns10881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The use of commercially available topical hemostatic adjuncts has increased the safety profile of surgery as a whole. Cranial surgery has also benefited from the development of numerous agents designed to permit more rapid achievement of hemostasis. Flowable topical hemostatic agents applied via syringe injection are now commonly employed in many neurosurgical procedures, including cranial surgery. Intravascular use of these strongly thrombogenic agents is contraindicated, but in certain settings, inadvertent intravascular administration can occur, resulting in vascular occlusion, thrombosis, and potential dissemination. To date, there have no reports detailing the presence and incidence of this complication.
Methods
The authors conducted a retrospective review of all cranial surgeries performed at Presbyterian University Hospital by members of the University of Pittsburgh Medical Center's Department of Neurological Surgery between 2007 and 2009. Cases complicated by vascular occlusion due to inadvertent intravascular administration of flowable topical hemostatic matrix (FTHM) were identified and analyzed.
Results
Iatrogenic vascular occlusion induced by FTHM was identified in 5 (0.1%) of 3969 cranial surgery cases. None of these events occurred in 3318 supratentorial cases, whereas 5 cases of cerebral venous sinus occlusion occurred in 651 infratentorial cases (0.8%). The risk of accidental vessel occlusion was significantly associated with infratentorial surgery, and all events occurred in the transverse and/or sigmoid sinus. No episodes of inadvertent vascular occlusion occurred during endoscopic surgery. No cases of arterial occlusion were identified. Of the 5 patients with FTHM-related cerebral venous sinus occlusion, none developed long-term neurological sequelae referable to the event.
Conclusions
Inadvertent intravascular administration of FTHM is a rare complication associated with cranial surgery that occurs most commonly during infratentorial procedures around the transverse and/or sigmoid sinuses. Modifications in the choice of when to use an FTHM and the method of application may help prevent accidental venous sinus administration.
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Abstract
Since ancient times we have attempted to facilitate hemostasis by application of topical agents. In the last decade, the number of different effective hemostatic agents has increased drastically. In order for the modern surgeon to successfully choose the right agent at the right time, it is essential to understand the mechanism of action, efficacy and possible adverse events as they relate to each agent. In this article we provide a comprehensive review of the most commonly used hemostatic agents, subcategorized as physical agents, absorbable agents, biologic agents, and synthetic agents. We also evaluate novel hemostatic dressings and their application in the current era. Furthermore, wholesale acquisition prices for hospitals in the United States are provided to aid in cost analysis. We conclude with an expert opinion on which agent to use under different scenarios.
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35
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Gu R, Sun W, Zhou H, Wu Z, Meng Z, Zhu X, Tang Q, Dong J, Dou G. The performance of a fly-larva shell-derived chitosan sponge as an absorbable surgical hemostatic agent. Biomaterials 2010; 31:1270-7. [DOI: 10.1016/j.biomaterials.2009.10.023] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022]
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36
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Krishnan S, Conner TM, Leslie R, Stemkowski S, Shander A. Choice of hemostatic agent and hospital length of stay in cardiovascular surgery. Semin Cardiothorac Vasc Anesth 2009; 13:225-30. [PMID: 19951982 DOI: 10.1177/1089253209351321] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemostatic agents (HAs) are efficacious in reducing blood loss during surgery, which may affect postoperative length of stay (LOS). The purpose of this study was to compare the expected and actual LOS by HA in cardiac procedures. Hospital claims data between 2003 and 2006 were extracted from a US service-level comparative database. Four cohorts for comparison were FLOSEAL, SURGICEL + thrombin, GELFOAM + thrombin, and other. Expected LOS was derived using 2006 Centers for Medicare and Medicaid LOS by diagnosis-related group, and 2-part regression models were created to assess outcome. A total of 36 950 discharges were included. FLOSEAL was associated with less likelihood of exceeding expected LOS compared with baseline (odds ratio = 0.791; P < .01). Among patients who did exceed expected LOS, FLOSEAL patients did so at a reduced rate (incidence rate ratio = 0.891; P < .01). Further assessment is warranted to distinguish products with favorable outcomes.
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37
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Abstract
Good hemostasis in surgery can provide multiple advantages to the patient, surgical team, and health care facility. Active and passive hemostatic agents have been widely used for many years and have extensive history supporting effective and safe use in a wide variety of surgical procedures. The type of surgical procedure, type of bleeding, hemostatic agent availability, and patient characteristics will influence the choice of topical hemostatic agent that is used by the surgeon. By actively participating in the coagulation cascade, active topical hemostatic agents are more able to meet the criteria of an ideal hemostatic agent in cases of oozing blood and minor bleeding during surgical procedures. Active agents can be used alone or in combination with passive agents. Familiarity with the products used to achieve hemostasis and their preparation can facilitate optimal use by surgical teams.
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38
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Ferschl MB, Rollins MD. Thromboemboli, Acute Right Heart Failure and Disseminated Intravascular Coagulation After Intraoperative Application of a Topical Hemostatic Matrix. Anesth Analg 2009; 108:434-6. [DOI: 10.1213/ane.0b013e31818d3f48] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Topical Hemostatic Agents. Dermatol Surg 2008. [DOI: 10.1097/00042728-200804000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Abstract
Topical hemostatic agents play an important role in both common and specialized dermatologic procedures. These agents can be classified based on their mechanism of action and include physical or mechanical agents, caustic agents, biologic physical agents, and physiologic agents. Some agents induce protein coagulation and precipitation resulting in occlusion of small cutaneous vessels, while others take advantage of latter stages in the coagulation cascade, activating biologic responses to bleeding. Traditional and newer topical hemostatic agents are discussed in this review, and the benefits and costs of each agent will be provided.
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Affiliation(s)
- Melanie D Palm
- Department of Dermatology, Rush University Medical Center, Chicago, Illinois 60612, USA
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41
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Terrab A, Pawlak D, Spaay P, Hoppensteadt D, Fareed J. Further removal of factor v related antigen from bovine thrombin by utilizing a membrane-filtration step. Clin Appl Thromb Hemost 2007; 14:135-40. [PMID: 18160573 DOI: 10.1177/1076029607308866] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Topical bovine thrombin is commonly used during surgery to maintain hemostasis and is rarely associated with abnormalities in hemostasis, including coagulopathies and bleeding. Coagulopathies may be related to the formation of cross-reactive antibodies to bovine factor V. Effectiveness of a new filtration step to remove factor V/Va from bovine thrombin was evaluated. A highly sensitive and specific Western blot capable of detecting minute amounts of factor V/Va and/or its fragments was developed. Samples were evaluated for bovine factor V related antigens using the Western blot method and a competitive enzyme-linked immunosorbent assay. Factor Va light chain fragment levels were detectable in crude thrombin and chromatographically purified thrombin but not in chromatographically purified and virally filtered preparations. Therefore, inclusion of the viral-filtration step during purification of thrombin is effective in reducing factor V or its fragments to undetectable levels, thus enhancing product purity.
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Affiliation(s)
- Abdel Terrab
- King Pharmaceuticals Inc., 2228 Pleasant View Road, Middleton, WI, USA.
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42
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Abstract
Hospital pharmacists are often consulted for their knowledge about coagulation and therapeutic interventions for the management of critical bleeding. Many pharmacotherapies are available for this purpose, both systemic and topical, and others are in development. These agents and their mechanisms of action are reviewed, and perspectives are provided regarding their use in various clinical settings. Also provided are associated precautions to promote safe use. Current controversies surrounding pharmacotherapeutic agents used to control serious bleeding (e.g., in various types of surgery, trauma, obstetrics, and intracranial hemorrhage) are also discussed.
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Affiliation(s)
- Stacy Voils
- School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond, Virginia 23298, USA.
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