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PubMedDate not supplied

Use of a collagen hemostatic closure device to achieve hemostasis after arterial puncture: a cost-effectiveness analysis.

PURPOSE: To evaluate whether a collagen hemostatic closure device is a safe, cost-effective alternative to manual compression for achieving hemostasis at arterial puncture sites. MATERIALS AND METHODS: A cost-effectiveness analysis, based on a meta-analysis of published data, was performed from the perspective of the health-care system. The gain in effectiveness was expressed as the decrease in rate of puncture-site complications that required treatment. Costs associated with achieving hemostasis and treating complications were included. RESULTS: Use of a collagen closure device decreased the number of puncture-site complications from 31:1,000 to 16:1,000. The average cost of using the device was $177 per patient compared with $42 per patient for manual compression. The incremental cost of averting one complication exceeded $9,000. CONCLUSION: Use of a collagen closure device to achieve hemostasis after an arterial puncture may reduce the complication rate, but the additional cost per complication averted is very high.

Aneurysm, False↗
PubMed2003

Arterial hemostasis using the Duett sealing device.

Using a liquid procoagulant, the Duett sealing device employs a distinctly different mechanism than other available devices for attaining hemostasis after femoral arterial puncture. Approved for use with 5 to 9 Fr sheath sizes, the Duett incorporates the typical vascular sheath in the closure procedure. Moreover, the liquid procoagulant, containing a mixture of thrombin and collagen, provides instant hemostasis and does not leave foreign material in the artery or in the subcutaneous tissues. Several studies, including one comparing the Duett to standard manual compression (SEAL), have shown the safety of the device as well as decreased times to ambulation. In addition, time to hemostasis was significantly decreased in patients receiving anticoagulation or antiplatelet therapy. The Duett sealing device is simple to use, safe, effective and a viable alternative to other available devices and/or manual compression.

Collagen↗
PubMed1996

Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial.

BACKGROUND AND STUDY AIMS: Rebleeding after initial endoscopic hemostasis remains an important determinant of poor prognosis in patients with ulcer hemorrhage. Prospective identification of patients who are at high risk for rebleeding, and directing further therapeutic measures in these patients, would be expected to improve the prognosis. PATIENTS AND METHODS: We used our previously described scoring system (the Baylor Bleeding Score) to identify patients at increased risk for rebleeding after initially successful endoscopic hemostasis, and randomized them into retreatment and no-retreatment groups. Patients in the retreatment group received additional endoscopic heat probe therapy at 24 hours, the follow-up was otherwise similar. Forty men with major ulcer hemorrhage were randomized, 19 to the retreatment group and 21 to the no-retreatment group. Patients in the two groups had similar Baylor Bleeding Scores, blood transfusion needs (median three vs. two units), ulcer sites (duodenal 57% vs. 43%), stigmata of hemorrhage (actively bleeding 68% vs 67%), and received similar initial endoscopic therapy (heat probe 240 J vs. 300 J). Patients in the retreatment group received additional heat probe therapy (median 165 J) at 24 hours. RESULTS: Rebleeding, requiring significantly more blood transfusion, occurred in 24% of the no-retreatment group patients compared to none of the retreatment group patients (p < 0.05). CONCLUSIONS: Endoscopic retreatment after successful initial endoscopic hemostasis prevents rebleeding in highrisk patients with ulcer bleeding.

Adult↗
PubMed1989

The effect of endoscopic hemostasis with alcohol on the mortality rate of nonvariceal upper gastrointestinal hemorrhage. A randomized prospective study.

One hundred and forty-five patients with nonvariceal upper GI hemorrhage, active or with stigmata (Forrest I and II) were divided into two groups according to the day of the week on which emergency endoscopy was performed: group A (78 patients) in which conventional treatment was applied (blood transfusions, antacids, cimetidine, pirenzepine), and group B (65 patients) in which endoscopic hemostasis with absolute alcohol (Asaki's method) was performed. The two groups were comparable as regards age, sex distribution and type of hemorrhage (after Forrest). Emergency surgery was performed in both groups if the bleeding did not stop or if it recurred. Twenty patients (11 in group A and 9 in group B) were operated on some time after the bleeding episode (5-18 days) to prevent new episodes. Absolute alcohol injection achieved hemostasis in all the cases of active hemorrhage (Forrest I) and prevented recurrence in 24 out of 25 cases with a clot or visible vessels (Forrest II), so that emergency surgery was not necessary in any of the patients of group B. Mortality rate was significantly lower in group B than in group A (10 deaths in group A, 2 in group B, p less than 0.05) being explained mainly by the reduced post-operative mortality (18% in group B), due to the small number of the operated patients (28 in groups A, 10 in B; p less than 0.02), especially of those operated on as an emergency (one in the endoscopic hemostasis group as compared with 17 in the conventional treatment group; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Argon beam coagulation for post-tonsillectomy hemostasis.

OBJECTIVE: The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post-tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser. METHODS: Two consecutive studies were performed as follows. In the first, a retrospective analysis of post-tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient-blind study of post-tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random. RESULTS: Post-tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood-streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total. CONCLUSION: ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.

Adolescent↗
PubMed2002

Spleen hemostasis using high-intensity ultrasound: survival and healing.

BACKGROUND: Previous studies have shown that high-intensity focused ultrasound (HIFU) can effectively control bleeding of incised livers and spleens and punctured vessels. This current study investigated the long-term safety of HIFU in splenic hemostasis. METHODS: A total of 21 rabbits were randomly assigned to two groups: HIFU treatment (n = 14), and sham treatment (n = 7). All animals underwent sterile laparotomy and splenic exposure. The HIFU-treated animals received splenic incisions, 8 to 10 mm long and 4 to 5 mm deep, and immediate 9.6-MHz HIFU until hemostasis was achieved. After recovery, ultrasound images, blood samples, and histologic samples were collected on days 0, 1, 3, 7, 14, 28, and 60. RESULTS: All 14 splenic injuries were hemostatic after an average of 96 seconds of HIFU application. There was evidence of rebleeding in one animal between days 3 and 7 posttreatment. Subsequent blood analysis showed no significant difference in serial hematologic or coagulation measures between HIFU and sham groups. Histologic examination up to 60 days posttreatment revealed scarring and spleen tissue regeneration at the treatment site. CONCLUSION: HIFU provides an effective and safe method of achieving hemostasis after acute splenic injury.

Animals↗
PubMed1997

Experimental studies with perfluoro-octane for hemostasis during vitreoretinal surgery.

PURPOSE: To investigate the effect of perfluoro-octane on coagulation studies and on intraoperative hemostasis during vitreoretinal surgery in an animal model. METHODS: In vitro study--comparison of coagulation profiles (bleeding time, whole blood clotting time, partial thromboplastin time, and one-stage prothrombin time) of blood taken from healthy volunteers with and without the addition of perfluoro-octane. In vivo study--comparison of times taken to achieve hemostasis in a rabbit model with large retinal arterial bleeding in vitrectomized and aphakic eyes with and without intraocular injection of perfluoro-octane. RESULTS: In vitro study--perfluoro-octane had no significant effect on coagulation profiles. In vivo study--intraocular perfluoro-octane significantly reduced the time to achieve hemostasis (P < 0.01) at all infusion bottle heights in vitrectomized and aphakic rabbit eyes. CONCLUSIONS: Perfluoro-octane may be used to control bleeding during vitreoretinal surgery. A direct effect on the clotting cascade could not be demonstrated.

Adult↗
PubMed1982

Hemostasis testing during massive blood replacement. A study of 172 cases.

A 24-hours service was organized to study changes in the hemostatic system in surgical patients undergoing massive transfusion for excessive bleeding during operation or in the early postoperative period. Hemostasis tests gave normal results in only 12(7%) of the 172 patients, while in the remaining 160(93%) one or more tests gave abnormal results. The platelet count was the most frequently abnormal, followed by the prothrombin time and plasma fibrinogen. Well-defined hemostatic disorders (such as DIC, heparinization and liver disease) were ascertained in 82 patients (48%). 78 patients (45%) had less specific laboratory abnormalities, with a particularly high incidence of thrombocytopenia and less pronounced alterations in the coagulation tests. Unlike the patients with defined disorders, the strong inverse correlation in this group between platelet count, prothrombin time, plasma fibrinogen, and the number of transfusions suggests that the laboratory abnormalities were induced by massive blood replacement. Standard schemas involving the administration of platelet concentrates and/or fresh-frozen plasma without evaluation of hemostasis did not help to reduce the incidence of abnormalities. These measures also failed to decrease the requirements for whole blood and/or packed red cells. Therefore, indiscriminate administration in the massively transfused postoperative patient of blood components based on preestablished schemes appears to be unjustified. An approach based on hemostasis screening, identification of the underlying disorder, directed therapeutic intervention and laboratory monitoring is likely to be more effective.

Disseminated Intravascular Coagulation↗
PubMed1984

Impairment of primary hemostasis and platelet function after alcohol ingestion in man.

The effect of alcohol ingestion on primary hemostasis was investigated in fasting healthy humans. Primary hemostasis was measured with the template bleeding time and platelet aggregation assayed with the turbidometric method. Blood was collected to study coagulation and fibrinolysis. 1 h after ingestion of 2 ml/kg body weight of 40% alcohol the plasma alcohol concentration was 19.3 +/- 1.6 mmol/l. At this time there was a significant prolongation of the bleeding time accompanied by an impairment of platelet responsiveness to both collagen and ADP. A prolongation of the bleeding time and impairment of platelet function was also found 2 h after alcohol ingestion. Ingestion of this amount of alcohol did not affect parameters of coagulation or fibrinolysis. The data indicate that primary hemostasis is impaired in man after ingestion of moderate amounts of alcohol. This may explain the favorable effect of moderate alcohol consumption on ischemic heart disease but indicates an increased risk for patients with bleeding.

Adenosine Diphosphate↗
PubMed2005

Successful endoscopic hemostasis for gastric arterial bleeding due to invasion of malignant lymphoma.

A 75-year-old male with malignant lymphoma (ML) accompanied with gastric lesion was treated with combination chemotherapy. The patient produced tarry stool on the 4th d, and emergency gastroscopy showed arterial bleeding from the lesion. Hemostasis was achieved by injecting pure ethanol and using hemostatic clips. There is only one previous report on endoscopic hemostasis being effective for bleeding due to lymphoma. Since gastric bleeding causes significant mortality, endoscopic hemostasis should be considered as first-line treatment for ML patients who were treated with chemotherapy.

Aged↗
PubMed2004

Liver hemostasis with high-intensity ultrasound: repair and healing.

OBJECTIVE: Previous studies have shown that high-intensity focused ultrasound can effectively control bleeding from injuries of liver, spleen, and blood vessels. This study investigated long-term hemostasis and tissue repair after high-intensity focused ultrasound treatment in liver. METHODS: A total of 21 rabbits were randomly assigned to 2 groups: high-intensity focused ultrasound treatment (n = 14) and sham treatment (n = 7). All animals had sterile laparotomy and liver exposure. The high-intensity focused ultrasound-treated animals received liver incisions, 20 to 25 mm long and 4 to 6 mm deep, followed immediately by high-intensity focused ultrasound application until complete hemostasis was achieved. After recovery, sonographic images, blood samples, and histologic samples were collected immediately and on days 1, 3, 7, 14, 28, and 60 after treatment. RESULTS: All 14 liver injuries were hemostatic after an average +/- SD of 78 +/- 44 seconds of high-intensity focused ultrasound application, with no rebleeding at any time point after the treatment. Subsequent blood analysis showed no significant difference in serial hematologic or coagulation measures between the high-intensity focused ultrasound and sham groups. Alanine aminotransferase and aspartate aminotransferase levels increased immediately after surgery by as much as 285% up to day 3 and returned to normal values by day 7. Hematocrit and white blood cell counts showed no statistically significant difference from normal values at all time points. Histologic examination up to 60 days after treatment revealed scarring and liver tissue regeneration at the treatment site. CONCLUSIONS: High-intensity focused ultrasound appears to provide long-lasting hemostasis of acute liver injury. Healing and repair mechanisms after high-intensity focused ultrasound application appear to be intact.

Animals↗
PubMedDate not supplied

[Drugs that alter hemostasis and regional anesthetic techniques: safety guidelines. Consensus conference].

Patients about to undergo surgery are often taking drugs that alter hemostasis and affect anesthesia, particularly when neuroaxial techniques are used for subarachnoid or epidural anesthesia. The aim of this paper is to provide safety guidelines for regional anesthesia in patients receiving hemostasis-altering drugs, in order to reduce the risk of bleeding. We offer a detailed discussion of patients treated with inhibitors of platelet aggregation (emphasizing that such treatment alone is not a contraindication for neuroaxial blockade although certainly guidelines must be followed), unfractionated heparin (anesthesia should be started at least 4 hours after administration of this drug or 30 minutes before, provided pulmonary arterial pressure is normal), low molecular weight heparin (which should be administered 12 hours before or 12 hours after the anesthetic technique), and oral anticoagulants (provision of regional anesthesia depends mainly on International Normalized Ratio monitoring). We also stress that removal of catheters should follow criteria similar to those listed above, that the risk of complications due to bleeding increases considerably in association with these drugs, and that adequate neurological monitoring is essential during postoperative recovery. Overall, the final decision to use regional anesthesia in patients receiving drugs that alter hemostasis must be made on an individual basis after assessment of benefit and risk.

Administration, Oral↗
PubMed2001

[Overview of the relevant aspects of the blood coagulation system--focus and cardiovascular hemostasis].

The hemostasis is a complex regulated system. It can be subdivided into the coagulation cascade, the fibrinolytic system, thrombocytes and cellular hemostasis. In atherosclerosis there are several systemic changes of the hemostasis and fibrinolysis, especially in diabetics. These alterations are markedly pronounced in patients with acute complications like acute coronary syndromes. The alterations in these patients constitute a prothrombotic state. To treat this procoagulant situation several drugs like antithrombins, antiplatelet drugs including glycoprotein IIb/IIIa-receptor antagonists, and others are used. This therapy itself can cause perioperative hemostatic disorders. Therefore, a close communication between cardiologist and cardiac surgeon is necessary to handle this complex situation.

Blood Coagulation↗
PubMedDate not supplied

[Changes in lipid metabolism and hemostasis in intravenous and intrahepatic transplantation of neonatal allogenic hepatocytes in conditions of experimental hypercholesterolemia].

We studied effects of neonatal hepatocytes transplantation (NHT) on lipid metabolism and hemostasis in experimental hypercholesterolemia. A positive NHT influence on lipid metabolism, lipid peroxidation and hemostasis was established. The experimental data evidence for preferential influence of intrahepatic NHT on lipid metabolism and hemostasis compared to intravenous NHT.

Animals↗
PubMed2005

[Changes in the coagulational hemostasis system in venous thromboembolism].

The work is based on the results of examination of 51 patients, suffering various clinical variants of venous thromboembolism. There were adduced such indexes of the coagulational hemostasis systems, as the coagulation activation, anticoagulant and fibrinolytic. It was established, that disorders in the coagulational hemostasis system may be manifested by increase in activity of the coagulation activation system or by decrease in activity of anticoagulant or fibrinolytic system. The disorders in the coagulational hemostasis system causes the pulmonary thromboembolism occurrence.

Adult↗
PubMed2005

[Hemostasis in patients with rheumatoid arthritis].

AIM: To study hemostasis with reference to rheumatoid arthritis (RA) activity, extraarticular manifestations and vascular damage. MATERIAL AND METHODS: We studied hemostasis in 104 RA patients. The following parameters were tested: partial thromboplastin time activation (PTTA), fibrinolytic activity (FA), prothrombin index, lupus anticoagulant (LA), mean platelet volume (PV), antibodies against cardiolipin (aCL) and antibodies against beta2-glycoprotein 1 (alphabeta2-GP1). The disease activity index was estimated by DAS-28 including tender and swelling joints count, erythrocyte sedimentation rate and disease global activity rated by the patient. RESULTS: We found out an increased number of platelets in 54.4%, prolongation of FA and PTTA in 72.5 and 12.5% patients. The rest blood coagulation tests were normal in most the examinees. The LA antibodies were absent, while aCL and alphabeta2-GP1 antibodies were identified in 10.6 and 14.4%, respectively. The number of platelets increased while hemoglobin decreased in relation to higher disease activity and PV was significantly lower in patients with extraarticular manifestations. No significant influence of vascular damage or comorbidities on hemostasis was found. CONCLUSION: No relation was established between coagulation factors and the disease activity except for increased number of platelets in patients with higher activity and lower PV in patients with extraarticular manifestations. However, patients with aCL and alphabeta2-GP1 need constant monitoring because of the risk to develop thrombosis.

Antibodies, Anticardiolipin↗
PubMedDate not supplied

[Effects of ionic and non-ionic roentgen-contrast media upon ex vivo hemostasis in rabbits].

The influence of ionic and non-ionic contrast media on the ex vivo hemostasis in rabbits was studied for ionic urografin (76 %), non-ionic ultravist-300, and non-ionic omnipaque-300 intravenously injected in medium and high doses (1.5 ml/kg and 3.0 ml/kg, respectively). Ionic urografin (1.5 ml/kg) almost did not influence the level of hemostasis ex vivo. Non-ionic contrast media (ultravist and omnipaque) in the medium diagnostic dose (1.5 ml/kg) activated the hemostasis, the effect being much more pronounced in the case of omnipaque. Dose-dependent action was observed for both ionic and non-ionic contrast media.

Animals↗
PubMed1990

Effects of method of hemostasis on wound-infection rate.

Adequate hemostasis is important in preventing postoperative wound infection. This study compared four methods of hemostasis: specific pinpoint vessel electrocautery (SPC), specific vessel ligation with 4-0 vicryl (SVL), nonspecific electrocautery of vessel plus excessive surrounding tissue (NSC), and nonspecific ligation of vessel and excessive surrounding tissue with 4-0 vicryl (NSL), on the rate of wound infection in rabbits that were contaminated with 10(6) Staphylococcus aureus. There was no statistical significant increase in the rate of wound sepsis when electrocautery was used in a fashion producing minimal nonviable tissue compared to specific vessel ligation. Electrocautery use for specific vessel hemostasis does not result in a higher wound infection rate in contaminated wounds.

Animals↗