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At least 847 records · Page 47Linked to original sources
PubMed2002

Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent.

OBJECTIVE: To determine whether FloSeal Matrix Hemostatic Sealant is a safe and effective means of controlling bleeding post-endoscopic sinus surgery (ESS) and to assess postoperative healing. DESIGN: Prospective clinical study. SETTING: University of Toronto. METHODS: Eighteen patients with FloSeal placed on a total of 30 operative sites post-ESS. Time to cessation of bleeding was assessed intraoperatively. Patients had the operative sites assessed at 30 days postoperatively. MAIN OUTCOME MEASURES: Effectiveness of FloSeal in controlling bleeding and aiding in healing of the operative site. RESULTS: FloSeal adequately controls postoperative bleeding in patients post-ESS. Healing was also not adversely affected. CONCLUSIONS: FloSeal is a safe and effective treatment for controlling blood loss after EES. It may also provide support to the middle meatus as well as improve healing of the operative site compared with the use of traditional nasal packing. However, randomized clinical trials are needed to further evaluate this.

Adult↗
PubMed1993

A liposome based platelet substitute, the plateletsome, with hemostatic efficacy.

The complexity of platelet mediated hemostasis has hindered development of a platelet substitute for transfusion therapy. In the current study, the hemostatic efficacy of a liposome based modality, the plateletsome, is demonstrated. A deoxycholate extract of a platelet membrane fraction, with a minimum of 15 proteins including GPIb, GPIIb-IIIa and GPIV/III, was incorporated into sphingomyelin: phosphatidylcholine: monosialylganglioside or egg phosphatide small unilamellar vesicles by reverse-phase/sonication and French press extrusion. These plateletsomes decreased bleeding by 67% in the tail bleeding time in rats made thrombocytopenic (platelets < 30,000/microliters) with external irradiation (7-9Gy) by Cesium source. Efficacy was also demonstrated in the thrombocytopathic, Fawn-Hooded rat, but to a lesser extent than in the thrombocytopenic animals. Direct plateletsome infusion to the tail wound was more effective than systemic administration for all effective preparations. On post-mortem examination, no pathologic thrombi were detected by gross and histopathologic examination of the lungs, livers, kidneys, or spleens of thrombocytopenic or normal animals after plateletsome infusion. No evidence of intravascular coagulation, monitored by levels of circulating fibrinogen and platelet counts, was observed when plateletsomes were administered intravenously to rabbits. No deleterious effect, either inhibition or hyperaggregability, on platelet aggregation studies in vitro was observed. While further refinements are clearly required, this study indicates that liposomes bearing specific platelet proteins may provide a basis for a clinically applicable platelet substitute.

Animals↗
PubMed1982

Stabilizing hemostatic clamp for arterial anastomosis in microneurosurgery. Technical note.

The authors describe a "stabilizing hemostatic clamp" of their own design for use in end-to-side anastomosis. Its application facilitates simultaneous stabilization and hemostasis of the cortical artery at the site where anastomosis is to be performed. Using this instrument, the authors have performed anastomosis of the superficial temporal artery with a branch of the middle cerebral artery in 60 patients. On evaluation of the clinical effects of the treatment and results of control angiography, and taking into account the authors' relatively small experience with this type of surgical treatment, they conclude that their new clamp facilitates this form of surgery.

Cerebral Revascularization↗
PubMed2004

Hemostatic dressings for the first responder: a review.

The military is interested in finding a hemostatic dressing that is effective in controlling hemorrhage from combat wounds, relatively inexpensive, and easy to transport. The fibrin dressing has existed for decades, but the military has been reluctant to use the dressing because it is not Food and Drug Administration approved, fairly expensive, and difficult to apply on certain wounds. Newer dressings such as the microporous polysaccharide hemosphere (TraumaDEX), mineral zeolite (QuikClot), poly-N-acetylglucosamine (HemCon), and microporous hydrogel-forming polyacrylamide (BioHemostat) dressings have addressed these deficiencies in that they are relatively inexpensive, easy to transport, and easy to apply. However, the effectiveness of these new dressings on wounds sustained in combat is still questionable according to studies and anecdotal reports from Operation Iraqi Freedom. More research is needed to draw definite conclusions about the effectiveness of these dressings in a combat setting.

Blood Coagulation↗
PubMed2000

Efficacy of a new hemostatic device, Adapty , after transradial coronary angiography and intervention.

A novel hemostatic device, Adapty (Medikit, Tokyo, Japan), was developed to achieve effective and comfortable hemostasis following transradial procedures. The device consists of a pad fixed to a transparent plastic plate and a self-adhesive strap. The catheter sheath is removed from the radial artery after the pad has been positioned precisely over the puncture site, with the strap attached to the plate. Compression pressure then is adjusted with the self-adhesive strap, as is required with occlusive clamps. Patients do not need to maintain hyperextension of the wrist after the procedure. The wrist can be mobilized immediately after application. The efficacy of Adapty was evaluated in prospective observations of 200 patients. The device was successfully applied in all patients immediately after sheath removal. No patient required interruption of compression because of pain, congestion or ischemia. Complete hemostasis was obtained in 199 patients (99.5%), and the device caused no vascular complications. This study demonstrates that Adapty is highly effective for achieving hemostasis after transradial procedures.

Aged↗
PubMed2001

Prothrombotic changes in hemostatic parameters and C-reactive protein in the elderly with winter acute respiratory tract infections.

Mortality rates attributable to cerebrovascular and ischemic heart disease increase among older adults during the winter. Prothrombotic changes in the hemostatic system related to seasonal factors, such as ambient temperature changes, and winter acute respiratory tract infections, may contribute to this excess seasonal mortality. A prospective nested case-control study was conducted to assess the impact of winter acute respiratory tract infections on fibrinogen, factor VII, factor VIIa, D-dimer, prothrombin fragment 1.2, PAI-1, soluble P-selectin and C-reactive protein (CRP) in older adults. The change in laboratory parameters from baseline (fall) to the time of infection in both middle-aged and elderly individuals was compared with matched non-infected controls. In older adult participants with winter acute respiratory tract infections, significant increases occurred in fibrinogen and C-reactive protein, but not in any other markers. The mean fibrinogen increased 1.52 g/L (38%) and the mean CRP increased 37 mg/L (370%) over baseline (both p <0.001). In a multivariate analysis, both infection and season were associated with the increase in fibrinogen, but only infection was associated with the CRP increase. Old age magnified the increase in CRP but not in fibrinogen. Winter acute respiratory tract infections induce an exaggerated inflammatory response in older adults. The associated increase in fibrinogen, an independent risk factor for ischemic heart disease, may be partly responsible for the excess winter vascular mortality.

Acute Disease↗
PubMed2002

Possible hemostatic effect of synthetic liposomes in experimental studies under flow conditions.

BACKGROUND AND OBJECTIVES: The possibility of developing synthetic platelet substitutes is a subject of current interest. We explored the possible hemostatic effect of synthetic phospholipid incorporated in multilamellar vesicles (MLVs) or intermediate unilamellar vesicles (IUVs) using a well-characterized experimental system with circulating human thrombocytopenic blood (10 min, 250 s(-1)). DESIGN AND METHODS: The ability of the liposomes containing different combinations of dipalmitoylphosphatidylcholine (DPPC), phosphatidylethanolamine (PE) and dipalmitoylphosphatidylserine (DPPS) to promote fibrin formation (%F) on the damaged subendothelium was morphometrically evaluated. Generation of thrombin in the system was monitored through prothrombin fragment F1+2 determination. RESULTS: IUV liposomes containing DPPC, 1DPPS:9DPPC, 1DPPS:3DPPC, 1PE:1DPPC increased fibrin deposition on the subendothelium (53.87 +/- 11.0%; 39.76 +/- 6.75%; 40.69 +/- 10.54% and 32.22 +/- 7.35%, respectively vs. thrombocytopenic blood 11.5 +/- 1.2%; p<0.05), while 9PE:1DPPS IUV liposome failed to promote a procoagulant effect. MLV liposomes containing DPPC alone, 1DPPS:3DPPC and 1PE:1DPPC showed a positive effect on fibrin deposition (85.50 +/- 5.95%, 59.86 +/- 11.55% and 43.73 +/- 7.84% respectively; p<0.05). However, no effect was observed in those experiments performed with liposomes containing 3DPPS:1DPPC. After perfusion experiments, the coagulation system became activated, but differences were not statistically significant vs. control experiments, except for MLV liposomes containing DPPC alone (p<0.05). INTERPRETATION AND CONCLUSIONS: These results confirm that, at an experimental level, liposomes containing phospholipids could potentially be used to improve hemostasis in patients with quantitative or qualitative platelet disorders.

Animals↗
PubMed1976

Topical hemostatic agents to reduce bleeding from cancellous bone. A comparison of microcrystalline collagen, thrombin, and thrombin-soaked gelatin foam.

In fifty-three dogs microcrystalline collagen, thrombin-soaked gelatin foam, and thrombin powder were evaluated as hemostatic agents when applied to bleeding cancellous surfaces after osteotomy of the greater trochanter using two quantitative models: one, a single osteotomy; the other, a double osteotomy. All three agents significantly reduced bleeding compared with the controls, the microcrystalline collagen being most effective. At three months there was no evidence that microcrystalline collagen and thrombin-gelatin interfered with bone healing after the greater trochanter was reattached with two wires.

Administration, Topical↗
PubMed2002

Recombinant factor VIIa: a universal hemostatic agent?

Recombinant factor VIIa (rVIIa) has proved effective for the treatment and prevention of hemorrhage in patients with inherited hemophilia A and B who develop inhibitors to factor VIII or IX, and patients with acquired hemophilia A. More recently, there is evidence that rVIIa may also be effective in the control of abnormal bleeding in a variety of other conditions, such as inherited factor VII deficiency, thrombocytopenia, Glanzmann's thrombasthenia, and liver disease. In some of the reports, rVIIa appeared to be effective in controlling massive hemorrhage in which there was no response to conventional measures. It is now considered by some to be potentially the first universal hemostatic agent. However, further prospective, controlled, and adequately powered clinical studies are clearly required. It will be of particular interest to determine the efficacy of rVIIa in conditions such as severe thrombocytopenia, severe von Willebrand disease, severe defects in platelet activation, and severe deficiencies of factors V, X, II, and fibrinogen in which effectiveness would seem to be unlikely based on our current understanding of mechanisms of action of rVIIa.

Factor VIIa↗
PubMed2004

Monitoring of hemostatic status in four patients being treated with recombinant factor VIIa.

Recombinant Factor VIIa (rVIIa) is a potent hemostatic agent for the management of refractory bleeding in patients with Factor VII deficiency or Factor VIII inhibitors. While the current recommended dose is usually effective, the most appropriate dose remains a subject of debate. Since factor VII levels and shortening of the pro-thrombin time do not appear to correlate with response, an appropriate laboratory marker of clinical response has not been identified. In this article we report changes noted in thrombin generation, platelet function and clot structure in blood from patients treated with rVIIa. Thrombin generation was assessed via a thrombin generation time (TGT) assay using a Hemodyne HAS instrument. Changes in clot structure were assessed as changes in clot elastic modulus in the HAS, changes in maximum amplitude in the TEG and changes in maximum clot firmness in the ROTEG. The cases presented confirmed improvement in thrombin generation with administration of rVIIa. The cases also illustrate that: a) in the factor VII deficient patient, 25% of the 90 microg/kg dose is sufficient to totally correct the defect, b) patients with high level factor VIII inhibitors may require significantly more than the recommended dose of 90 microg/kg, c) thrombin generation may not be completely corrected despite dramatic shortening of the prothrombin time, and d) increasing rVIIa doses does not by itself ensure improved thrombin generation.

Aged↗
PubMedDate not supplied

Response of human pulp capped with a bonding agent after bleeding control with hemostatic agents.

PURPOSE: This study evaluated the response of human pulps capped with a bonding agent after bleeding control with different hemostatic agents. MATERIAL AND METHODS: Twenty-five Class II cavities were prepared in 25 caries-free human premolars scheduled for extraction due to orthodontic treatment. The pulp exposures were performed on the occlusal floor. The teeth were randomly divided into five groups. Groups 1-4 were capped with an adhesive system after hemostasis with different agents: Group 1--saline solution; 2--ferric sulfate; 3--2.5% NaOCl; 4--Ca(OH)2 solution. In Group 5, after hemostasis with saline solution, the pulp was capped with calcium hydroxide (control group). Then, ScotchBond Multi Purpose Plus was applied and the resin composite Z-100 placed incrementally according to the manufacturers' directions. After 60 days, the teeth were extracted and processed for light microscopic examination (HE) and the groups were categorized in a histological score system. The data were subjected to a non-parametric test (alpha=0.05). RESULTS: Overall, the histological features showed that the pulp response from Groups 1 through 4 was inferior to the response from Group 5, where dentin bridging occurred. In all groups, where the adhesive system was used for capping, the pulp response varied from an acute inflammatory, with varying degrees, to necrosis. No dentin bridge was formed after adhesive capping.

Adolescent↗
PubMed2005

Absorbable cyanoacrylate as a vascular hemostatic sealant: a preliminary trial.

No absorbable cyanoacrylate tissue adhesive for safe internal surgical use is available. This prospective multicenter preliminary study was designed to evaluate the safety and effectiveness of an investigational absorbable cyanoacrylate (IAC) as an adjunct to hemostasis in arteriovenous shunt (AVS) procedures for dialysis access. Consenting adults (10) underwent placement of expanded polytetrafluoroethylene (ePTFE) upper extremity vascular grafts for AVS access using continuous 5-0 or 6-0 polypropylene after heparinization (> or =3000 units i.v.). Arterial anastomoses were evaluated after sealing with IAC followed by 120 seconds of polymerization time. After vascular clamp removal, the mean time to hemostasis was 9.1 +/- 28.8 seconds. Additionally, 90 per cent (9/10) and 100 per cent (10/10) achieved hemostasis by 1 and 5 minutes, respectively. No patients required further adjunctive hemostatic measures. Adverse event safety data analysis through 12 weeks revealed occlusion of graft or vessel in four patients and graft thrombosis in one patient, all thought unrelated to sealant use. Other unrelated adverse events (bleeding, death, deep venous thrombosis, edema, erythema, hematoma, infection, and rash) occurred in single patients. Thus, IAC could be a useful sealant for vascular procedures with a potentially satisfactory safety profile. Larger, randomized, multicenter, prospective trials to further evaluate the use of this material are indicated and appropriate.

Adult↗
PubMed2005

Ultra-early hemostatic therapy for primary intracerebral hemorrhage: a review.

Stroke is a major health problem worldwide, causing high morbidity and mortality. Intracerebral hemorrhage (ICH) accounts for 10% of stroke cases in the United States and Europe and up to 30% in Asian populations. Intracerebral hemorrhage is less treatable than other forms of stroke and causes higher morbidity and disability. Data suggest that early hematoma growth is the principal cause of early neurological deterioration after ICH. Prospective and retrospective studies indicate that early hematoma growth occurs in 18-38% of patients scanned within three hours of ICH onset, and that hematoma volume is an important predictor of 30-day mortality. Recombinant activated factor VII (rFVIIa, NovoSeven), a powerful initiator of hemostasis, is approved for the treatment of bleeding in patients with hemophilia and inhibitors, and can also promote hemostasis in patients with normal coagulation. A Phase-IIB randomized, double-blind, placebo-controlled, dose-ranging trial has been conducted in 399 patients with ICH to investigate the potential of rFVIIa as an ultra-early hemostatic therapy. A reduction in hematoma growth in non-coagulopathic ICH patients was evident with reduced mortality and improved clinical outcome at three months. The significance of these findings for neurocritical care is discussed.

Cerebral Hemorrhage↗
PubMed2006

[Topic usage of bismuth subgallate as a hemostatic in tonsillectomy].

The most feared complication for the ENT specialists in the adenotonsillectomy is the immediate or mediate haemorrhage after surgery. We revise the literature and contrast experiencies with other colleage. We have found an astringent substance (bismuth subgallate), which helps us give an exact intraoperative diagnosis of the bleeding spot by the colour contrast it shows, and serves us also as a hemostatic, since it activates the XII factor in coagulation. We revise this product regarding its origen, prentation, applications and toxic effects.

Administration, Topical↗
PubMed1990

[Endobronchial use of hemostatic drugs feracryl and amifer].

The results of endoscopic administration of hemostatic agents feracryl and Amifer in 147 cases are analysed. In 123 patients 5-10 ml of 1% feracryl were administered after endobronchial bioptic manipulations. Bleeding after collection of bioptic material from the bronchial mucosa was arrested by this method in 69 cases. Moderate bleeding in 42 cases was arrested by pressing to the wound surface a tampon saturated with a feracryl solution. Endoscopic occlusion of a bleeding bronchus by means of feracryl and Amifer was conducted in 16 patients with various forms of lung tuberculosis complicated by hemoptysis and pulmonary hemorrhage. In 9 cases with massive pulmonary hemorrhage 3-4 ml of 20% Amifer solution was administered by endobronchial route into the bleeding area. In 7 cases up to 10 ml of feracryl was introducedby ++endobronchial route. Temporary endoscopic hemostasis in patients with various forms of pulmonary tuberculosis made it possible to postpone an emergency operation for a period of up to 2 weeks in all cases. For the prevention of aspiration pneumonia the bronchi were repeatedly cleansed in 8 patients and therapeutic lavage of the bronchi was carried out in 7 patients.

Acrylic Resins↗
PubMed1989

[Peculiar computed tomographic images after intracranial use of microfibrillar collagen hemostat: report of three cases].

After the intracranial application of microfibrillar collagen hemostat (Avitene), CT revealed contrast enhancement suggestive of brain abscess or residual or recurrent tumor in three patients. The first case was a 22-year-old male with left ventricular oligodendroglioma. At operation Avitene was applied to the ventricular wall and incised frontal lobe. Two months after the operation CT revealed ring enhancement at the left frontal lobe and ventricular enlargement. Craniotomy was performed again. Histological examination, however, revealed no recurrent tumor but residual Avitene and granulation. The second case was a 57-year-old female with left parietal glioblastoma multiforme. At operation Avitene was applied to the tumor cavity. Two months after the operation CT showed ring enhancement and craniotomy was performed again. Histological examination revealed residual Avitene and necrotic tissue. Five months after the first operation, craniotomy was performed for the third time, because recurrence was suspected after a CT scan. Histological examination revealed recurrent tumor and residual Avitene. The third case was a 19-year-old male with left frontal astrocytoma. Two months after the operation when Avitene was used for hemostasis, marked ring enhancement was observed. Five months after the operation, however, enhancement in CT was weak. The CT findings in these patients were characterized by the abnormally long duration of enhancement (five months) and by enhancement more marked two to three months after the operation than immediately after it. Based on these findings brain abscess or residual or recurrent tumor rather than normal healing was more suspect as the cause of this phenomenon. Brain abscess was ruled out, because the peripheral leukocyte count, erythrocyte sedimentation rate, CRP, etc. were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗