Use of PerClot® in head and neck surgery: a Scottish centre experience

Objective

PerClot^® is a biocompatible, polysaccharide haemostatic system recommended for surgical procedures. It is an absorbable modified polymer that is non-pyrogenic and is derived from purified plant starch. Our goal was to evaluate the safety, efficacy and usefulness of PerClot^® in head and neck surgery (H&N) in our department.

Methods

All patients who received PerClot^® after their neck operation over 1-year period (2019–2020) were prospectively investigated. The information collected included demographics, admission and discharge dates, type of operation, operative details, postoperative complications and their management. The data were collected and analysed using Excel.

Results

A total of 57 patients (males = 26, females = 31) with mean age of 51 (range 19–83) were identified. None of the patients developed primary or secondary haemorrhage. Ten patients suffered from post-operative wound complications (18%). Wound infection was noticed in 9/57 (16%) of patients. 1/57 patients had seroma.

Conclusions

PerClot^® is safe, effective in reducing the postoperative bleeding and would appear to be useful in head and neck surgery with minimal adverse effects.

Prospective randomized study evaluating the effects of PerClot® (Polysaccharide Hemostatic System) application in patients with high bleeding risk undergoing cardiac rhythm device implantation

BACKGROUND

Thus far, the topic hemostatic agent PerClot® is used for surgical procedures. Data about the use of PerClot® for cardiac-rhythm-devices (CRD) implantation are missing. The aim of this study was to evaluate the safety and efficacy of PerClot® in patients with high bleeding risk.

METHODS AND RESULTS

In this prospective randomized study we planned to include 150 patients admitted for CRD-Implantation receiving anticoagulation and/or dual-antiplatelet-therapy. Participants were randomized to receive PerClot® versus standard-of-care. The primary endpoint was the incidence of pocket hematoma. Safety endpoint was pocket infection. After a planned safety-interim-analysis the study was terminated early because of safety concerns. 51 patients were included. The two groups were comparable with regard to age (73±11years vs. 74±10years; p=0.71), CHA₂DS₂VASc (3.6±1.5 vs. 4.0±1.5; p=0.27) and HASBLED-Score (2.4±1.1 vs. 2.5±1.0; p=0.98), CRD or procedure type, anticoagulant or anti-platelet therapy. The use of PerClot® resulted in a higher incidence of postoperative fever (7 (28%) vs. 0 (0%); p=0.004), higher C-Reactive Protein (66.1±50.5mg/l vs. 25.9±22.5mg/l; p=0.002); and higher postoperative white blood cell count (13.5±4.3/nl vs. 8.8±2.6/nl; p<0.001). Hematoma formation did not differ significantly (p=0.14). Reoperation was not necessary in any patient.

CONCLUSION

This first randomized controlled study for the topical use of the hemostatic agent PerClot® in CRD implantation was terminated early by the safety monitoring board because of an augmented rate of fever and inflammatory markers in the PerClot® group. The addition of PerClot® does not suggest a benefit with regard to the frequency of pocket hematoma.