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In dogs with experimentally created oral wounds, Avitene proved to be superior to Gelfoam or Surgicel as a topical hemostatic agent. No postoperative problems were encountered. All sites healed equally well and there was no discernible histological difference between results with Avitene and with the other agents.
Lysine vasopressin and a long-acting analogue N alpha-triglycyl-lysine vasopressin were compared in a prospective randomized double-blind study including 71 women undergoing cold knife conization of the uterine cervix. Hemodynamic and hemostatic variables were studied. N alpha-triglycyl-lysine vasopressin had the following advantages over lysine vasopressin: it gave significantly less skin pallor, becoming evident at a later stage during the operation. The diastolic blood pressure was significantly lower, as also was the incidence of postoperative hemorrhages. Factor VIII related antigen was lower. On the other hand reduction in heart rate (values before conization compared with values during conization) was more pronounced when N alpha-triglycyl-lysine vasopressin was used, but there was no difference in absolute values between the two groups during conization.
One hundred and ninety seven patients with upper gastrointestinal bleeding were each administered and endoscopic local injection of hypertonic saline epinephrine (HS-E) solution at our hospital over a 5-year period, from the Spring of 1981 to March of 1986. Peptic ulcers were found in 162 of the patient. Vessels could be visibly detected in the 148 (91.4%)-A group, but not in the 14 (8.6%)-B group. A comparison of the number of endoscopic local injections to each of these groups indicated no significant differences in types of bleeding, systemic complications, or sites of bleeding. The excellent hemostatic effect of HS-E is due to the fact that local injection of its solution can be repeated in large quantities for various types of bleeding.
The results of emergency endoscopic treatment of severe non variceal bleeding in the upper and lower gastrointestinal tract by hemostatic injections are reported. Most of the 44 patients were seriously ill and had a high surgical risk. Definitive hemostasis was obtained in 88.6 per cent of cases. Twenty-five patients had active bleeding which was arrested in 84 per cent of cases. There were no serious complications related to the technique. The overall survival rate was 52 per cent. Ten of the 13 deaths were not due to gastrointestinal hemorrhage. The authors advocate this simple, effective and inexpensive method as the initial treatment of ulcerated gastrointestinal bleeding in critically ill patients.
The bonding of methylmethacrylate to cancellous bone was tested in shear both in control specimens and in those in which microfibrillar collagen had been previously used as a hemostatic agent. The breaking load and energy to failure were significantly lowered by the microfibrillar collagen.
Bovine peptide-B from fibrinogen was active in the hemostasis of rat tail arterioles. The time of bleeding exhibits an inverse log proportionality to the concentration of bovine peptide-B. The peptide produced a 10-fold decrease in the time of bleeding at the highest concentration tested. Prolonged incubation of the peptide with the system was unnecessary and it appeared to participate immediately as a hemostatic agent. These findings suggest that hemostasis was due to vasoconstriction since coagulation time remained constant as the bleeding time decreased with increasing concentration of peptide-B. Bovine peptide-B is interpreted as a physiological substance which probably acts on some smooth muscle receptor.
The three topical hemostatic agents--gelatin paste, microfibrillar collagen, and gelatin sponge soaked in thrombin--individually were effective in reducing bleeding from cancellous bone, as tested on the femoral surface of trochanteric osteotomies during total hip replacement. During a three-minute interval, the spontaneous reduction in bleeding in eight control hips to which no agent was applied was 11 per cent. Gelatin paste gave a reduction of 85 per cent; gelatin sponge soaked in thrombin, a reduction of 75 per cent; and microfibrillar collagen, a reduction of 47 per cent. None of these agents interfered with healing of the trochanteric osteotomy.
Hemorrhage from esophagogastric varices has been treated in 15 patients by an interruption of the portal-azygous venous circulation. The venous pedicles of the stomach were ligated, and a hemostatic suture was placed around the circumference of the stomach at the level of its upper and middle thirds. The procedure was effective in controlling massive acute hemorrhage caused by portal hypertension. One operative death occurred. During follow-up observations of eight months to five years, only one patient had mild recurrent hemorrhage at the end of the second year. Four patients died late of liver failure. This method of the anatomic interruption between portal and azygous venous circulation was simple, rapidly performed and relatively safe in patients with massive bleeding gastroesophageal varices which had not responded to conservative therapy.
Hemocoagulation was studied in 78 patients with diabetes mellitus during the treatment of diabetic retinopathy with antiaggregating and hemostatic drugs. Trental and acetylsalicylic acid decrease an elevated aggregating activity of the blood platelets, improve hemocoagulation indices, accompanied by stabilization of the retinal pathologic process. The combined dicynone-acetylsalicylic acid treatment is recommended in a raised coagulating activity of the blood.
The liver wound healing dynamics under the influence of a new hemostatic preparation kaprofer was studied in experiment on 61 rabbit. During the histological investigation it was determined that while putting on the preparation on the wound the fibrinous clot of light brown colour is generated immediately; on the second day the wound surface has a light brown colour, fibrin patch at the centre; on the fourth day she has a whitish colour due to the cicatrix formation; on the eighth day the cicatrix is formed, and abundantly vascularized cicatricial and fibrillar tissue zones.
It has been shown that StE can significantly shorten PT, TT, KPTT and RT of experimental animals and has an antiheparin function in the body. Meanwhile, it can significantly shorten ELT and strengthen FA. Its hemostatic action is accomplished through promoting coagulation and inhibiting fibrinolysis. 3P test and EG test were negative, it is thus impossible for a large dosage of StE to lead to DIC.
It has been reported that aprotinin (apr) is effective for hemostasis during and after the extracorporeal circulation (ECC) for cardiac or great vessel surgery. However its mechanism remains still obscure. In this study, we observed relationships between changes in interleukin-8 (IL-8), endothelial factors, or D-dimer and aprotinin administered before and after the ECC. Fourteen patients in whom cardiac or great vessel surgery was done using ECC were divided randomly into two groups. Seven subjects in Group I (G-I) were infused 10(6) KIU of apr immediately after anesthesia, immediately before and after the ECC, respectively, and 10(6) KIU of apr were also added during the ECC. Seven other subjects (G-II) were infused 10(6) KIU of apr immediately before and at three hours after the ECC, and also 2 x 10(6) KIU of apr immediately after the ECC. No marked hemorrhagic tendency was noted in all subjects and increase in plasma D-dimer was not marked. Immediately after the ECC, granulocyte elastase in plasma increased markedly in both groups but subsequently decreased in the G-II alone while it remained unchanged in the G-I. Similar changes were observed in plasma IL-8 values. During the ECC, intercellular adhesion molecule-1 in plasma decreased in both groups but von Willebrand factor activity decreased in the G-I alone. From the above data, the hemostatic effect of apr may contribute to protect the dysfunction of endothelial cells or to enhance recovering from the dysfunction during the ECC.
The article presents summarized results of treatment and examinations of 216 patients with gastro-intestinal bleedings due to acute errosive hemorrhagic gastritis and gastroduodenitis, cancer and polyposis of the stomach, liver cirrhosis and portal hypertension, hemorrhage against the background of atherosclerosis and arterial hypertension by administration of hemostatic medicine into the lymphatic system for activation and reinforcement of the reserve monocyte-macrophage mechanism of hemocoagulation. The results obtained confirm the expedience of this method of influencing the monocyte-macrophage hemostasis, having no complications and giving better medical effects.
The techniques for resection of hepatic tumors have traditionally been based on lobar anatomy. The morbidity and mortality associated with hepatic resection have been most closely correlated with intraoperative blood loss. The results of 37 hepatic resections for secondary neoplasms were retrospectively reviewed. This group included 18 patients who underwent anatomic resections and 19 patients who underwent nonanatomic resections. The nonanatomic group experienced significantly less blood loss, shorter operating times, shorter hospital stays, and no significant difference in long-term survival. A positive relationship between blood loss and postoperative complications is demonstrated for the combined groups. These results support the use of nonanatomic resection whenever feasible for secondary hepatic tumors. We describe the technique for nonanatomic hepatic resection for metastatic lesions, with special emphasis on hemostatic techniques.
OBJECTIVE: To determine if a pressure dressing containing fibrinogen and thrombin could provide more effective control of arterial hemorrhage than a pressure dressing alone in an animal model of arterial injury. DESIGN: Randomized acute (nonsurvival) experiment in swine. SETTING: Federal biomedical research institute. ANIMALS: Six anesthetized Yorkshire swine. INTERVENTIONS: Uncontrolled arterial hemorrhage was induced in anesthetized swine by creating femoral artery lacerations. Hemorrhage was controlled by a gauze bandage containing fibrinogen and thrombin, applied with 1 minute of 3.5-kg pressure. The dressings were left in place for 1 hour after the pressure was removed. The contralateral limbs received identical treatment with plain gauze dressings. MAIN OUTCOME MEASURES: Total blood loss, mean arterial pressure, and mortality were measured after 1 hour. RESULTS: After 1 hour, blood loss in the fibrin bandage group was 123 +/- 48 mL, compared with 734 +/- 134 mL in the control group (P = .0022). In the group treated with the fibrin bandages, there was no significant decrease in the mean arterial pressure after arterial laceration. In contrast, there was a decrease of 30 mm Hg in the group treated with gauze dressings alone. There was no animal mortality during the study period. CONCLUSIONS: Bandages containing fibrinogen and thrombin significantly reduced the amount of blood loss and allowed mean arterial pressures to be maintained in animals with uncontrolled hemorrhage from femoral artery lacerations. A hemostatic bandage may be an important adjuvant for controlling severe extremity hemorrhage in the prehospital setting.
Bleeding is very rare in patients with lupus anticoagulants in the absence of associated hemostatic abnormalities. Few cases have been reported with attention given to work-up for other coagulation defects. We report a case of spontaneous hematoma in a patient with lupus anticoagulant, immunoglobulin (Ig)M anticardiolipin antibodies, and no other associated abnormalities.
Changes of hemostatic parameters during percutaneous transluminal coronary angioplasty (PTCA) in 75 patients with chronic coronary artery disease were evaluated. Plasma levels of D-dimer, soluble fibrin monomer, plasmin-alpha2 antiplasmin inhibitor complex, and tissue factor (TF) were significantly increased in all patients with chronic coronary artery disease. The activity of antithrombin and protein C and the levels of protein C antigen were significantly decreased 1 hr after PTCA, but they returned to normal range 1 day after PTCA. There was no significant difference in the level of plasma APC-PCI complex before and 1 hr after PTCA. The plasma levels of D-dimer, soluble fibrin monomer, thrombomodulin, TF and PPIC were significantly decreased 1 hr, and the plasma levels of plasmin-alpha2 antiplasmin inhibitor complex 1 day after PTCA. These findings suggest that the decrease of protein C and antithrombin resulted in activation of the coagulation system. One hour after PTCA, the plasma levels of (total-free) TF pathway inhibitor (TFPI) were significantly decreased, but the plasma levels of total and free-TFPI were significantly increased, suggesting that consumption of (total-free) TFPI occurs during PTCA. Overall, these findings suggest that the hypercoagulable state improves during PTCA and that transient decrease of antithrombin, protein C, (total-free) TFPI or plasmin-alpha2 antiplasmin inhibitor complex may cause restenosis of coronary artery.
Twenty-eight patients undergoing cardiac surgery were prospectively studied and were assigned to two groups. The patients received 0.8- (Group L) or 2.0-fold (Group H) dose of protamine for the neutralization after cardiopulmonary bypass (CPB) which was determined by Hepcon HMS(R) assay system in which the reagent chamber containing the concentration of protamine that completely neutralized the heparin had the shortest clotting time. Mean dose of protamine was 1.60 +/- 0.50 mg kg(-1) in Group L, and 3.56 +/- 1.48 mg kg(-1), respectively. Activated clotting times (ACT) were comparable between the two groups through this study period. In Group H, platelet counts significantly decreased to 69% of that before protamine administration, and plasma platelet factor 4 level significantly increased to approximate 2-fold of that before protamine administration just after protamine administration, respectively. However, these phenomena were not observed in Group L. In addition, these hemostatic changes occurred transiently just after protamine administration. We conclude that the low-dose protamine may prevent transient platelet depletion following CPB. Low-dose protamine can neutralize anticoagulation effect of heparin sufficiently and may mitigate protamine-induced platelet dysfunction.