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PubMed2006

Altered hemostasis in migraineurs studied with a dynamic flow system.

INTRODUCTION: Livedo reticularis (LR) refers to the violaceous netlike pattern of skin related to arteriopathy at the dermis-subcutis border. Livedo is associated with migraine, and among migraineurs, LR is more common in those with prior stroke. Other evidence of vascular perturbation in migraine comes from studies showing elevated von Willebrand factor (vWF). The purpose of this study is to evaluate global hemostasis in migraineurs, including the subset with LR, using a dynamic flow system simulating physiological conditions, and measuring vWF activity and antigen levels. MATERIALS AND METHODS: Patients with migraine were enrolled from the headache clinic and presence or absence of LR was noted. Age-matched healthy, non-migraine, LR-free individuals were recruited as controls. To evaluate hemostasis, we used the Clot Signature Analyzer (CSA) measuring platelet hemostasis time (PHT), collagen-induced thrombus formation (CITF), and clot time (CT). vWF activity and vWF antigen levels were also measured. RESULTS: The mean vWF activity level (142.7 vs. 103.4, p<0.01) and antigen level (132.1 vs. 104.5, p<0.05) were higher, and all three hemostasis parameters shorter in the episodic migraineurs than in the controls. The subset of migraineurs with LR had the highest vWF activity (155+/-59, p<0.05) and vWF antigen (141+/-43, p<0.05) levels, and the shortest PHT (3.7+/-1.6, p<0.05). In this subset there was a significant inverse correlation between vWF activity and PHT (r=-0.51, p=0.01). CONCLUSIONS: For migraineurs, the differences from controls in vWF and PHT are most robust in the LR subset, with the inverse correlation suggesting that endothelial perturbation may be causally related to the response of the platelets.

Adult↗
PubMed1997

Hemostasis parameters during ovarian stimulation for in vitro fertilization: results of a prospective study.

OBJECTIVE: To evaluate the effect of IVF-ET on the hemostatic system. DESIGN: Prospective clinical study. SETTING: Apparently healthy age-matched women of the hospital staff at various stage of the menstrual cycle. PATIENT(S): Twenty-five women involved in a IVF-ET program at the Department of Obstetrics and Gynecology, Montpellier University Hospital. INTERVENTION(S): Twenty-six hemostasis parameters evaluated repeatedly in patients undergoing IVF-ET. MAIN OUTCOME MEASURE(S): Blood cell-dependent hemostasis parameters and plasmatic coagulation factors, determined at pituitary desensitization, maximal E2 level, and P plateau. RESULT(S): Activation of the hemostatic system is evidenced at the P plateau, when D-dimers and fragments 1 + 2 of the prothrombin levels rose dramatically. At E2 peak, no significant modification of hemostasis markers was noted. CONCLUSION(S): The present results indicate that ovarian hyperstimulation may induce hemostasis activation at the P plateau. The role of supraphysiologic sex hormone levels on the hemostatic system requires further investigation.

Adult↗
PubMed2003

Utility of in vitro closure time test for evaluating platelet-related primary hemostasis in dialysis patients.

BACKGROUND: The platelet aggregation and skin bleeding time (SBT) tests currently used for assessment of hemostasis impairment in dialysis patients have important disadvantages. The authors explored the utility of a novel in vitro closure time test (PFA-100, platelet function analyzer) in which the process of platelet adhesion and aggregation after vascular injury is simulated in vitro in dialysis patients. METHODS: Thirty-four long-term dialysis patients were included in the study with 30 healthy volunteers as the control group. In vitro closure time was compared with results from the platelet aggregation and SBT tests. RESULTS: In vitro closure time identified more patients and fewer controls with hemostasis impairment. In the patient group, 60%, 40%, and 20%, and in the control group, 0%, 10% and 3% of persons were found to have hemostasis impairment as determined by in vitro closure time, platelet aggregation, and SBT, respectively. In addition, values for patients and controls were significantly different for in vitro closure time (P < 0.05) but not for platelet aggregation or SBT. Thus, closure time appears to be more sensitive and specific than the other 2 tests. No correlation was found between the 3 tests, either in patients or in controls. However, a high correlation (r = 0.73; P < 0.0001) was found between the 2 types of in vitro closure time test (collagen/epinephrine [CEPI] and collagen/adenosine diphosphate [CADP]) in patients and controls. CONCLUSION: These results indicate that in vitro closure time can be a useful test for detecting platelet-related primary hemostasis defects in dialysis patients.

Aged↗
PubMed2002

Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation.

BACKGROUND AND AIMS: Endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation have been proven effective in the hemostasis of bleeding peptic ulcers. However, the hemostatic efficacy has not been investigated in bleeding marginal ulcers. The aim of this study is to investigate the hemostatic efficacy of endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation in bleeding marginal ulcers. METHODS: From November 1997 to July 2000, 50 patients with active marginal ulcer bleeding underwent either hemoclipping (20 patients) or dual therapy (30 patients) for hemostasis. The demographic data, clinicopathological characteristics, endoscopic findings, initial hemostatic rates, rebleeding rates, amount of blood transfusion, the need of surgery, and mortality rates were collected and analyzed. RESULTS: Marginal ulcers were located at the anastomotic site (64%), saddle portion (22%), efferent loop (10%), or at the afferent loop (4%). The bleeding stigmata were classified into spurting artery (32%), oozing vessel (38%), visible vessel (20%), and blood clot adhesion (10%). The overall therapeutic results in 50 patients were initial hemostasis (100%), rebleeding rate (22%), need for surgery (4%), and hospital mortality rate (4%). There was no significant difference in demographic data and clinicopathological characteristics between the two modes of treatments, whereas recurrent bleeding developed in 5% in the hemoclipping group and 33% in the dual therapy group. No complication related to the procedure occurred in either mode of therapy. The hospital mortality rates were 0 and 6.7%, respectively. CONCLUSION: Endoscopy is effective in achieving initial hemostasis from bleeding marginal ulcers. However, the rebleeding rate remains high and repeated endoscopy may be needed to arrest the hemorrhage.

Adrenergic Agonists↗
PubMed1976

Laboratory modalities for assessing hemostasis during cardiopulmonary bypass.

This discussion has outlined several simple and reliable test systems which have been found useful in assessing disorders of hemostasis in the hemorrhaging CPB patient. When these tests are utilized as described in the preceding article, they have been extremely helpful in studying hemostasis in the CPB patient to be reexplored; they are equally helpful to quickly render a differential diagnosis of altered hemostasis when hemorrhage occurs. In addition, several "special" procedures, the AT-III and heparin assays, have been reviewed; these have been found quite useful in special instances of CPB hemorrhage, and community cardiovascular teams may wish them to be available. This paper has not presumed to be "authoritative" with respect to the "best" tests for assessing CPB hemostasis, but rather has offered only an approach helpful to the authors. The intent has, however, been to provide guidelines for instituting simple, reliable, and workable procedures for the community hospital where CPB is now routinely performed.

Antithrombins↗
PubMed1978

Alterations of hemostasis associated with malignancy: etiology, pathophysiology, diagnosis and management.

As outlined in this paper, the patient with disseminated malignancy suffers many alterations of hemostasis; in addition, hemorrhage or less commonly thrombosis is the final clinical event in many of these patients. Patients with malignancy present a major clinical challenge in this day of new oncological awareness and more aggressive care. Thus, it is important to realize that these alterations of hemostasis do exist and they must be approached in a logical manner with respect to diagnosis as well as efficacious therapy. By far the most common alteration of hemostasis in malignancy is that of hemorrhage associated with thrombocytopenia either drug-induced or from bone marrow invasion. However, hemorrhage due to disseminated intravascular coagulation is also quite common. In addition, many antineoplastic drugs, as well as radiotherapy, may lead to hemorrhage in these patients. Thrombosis, which is also commonly seen in the patient with malignancy, is usually a manifestation of disseminated intravascular coagulation manifest as an intravascular thrombotic rather than an intravascular proteolytic event. When suspecting this, confirmatory laboratory evidence must be sought and the patient treated apropriately. When approaching the patient with malignancy and either hemorrhage or thrombosis, all of the potential defects in hemostasis must be taken into account, defined from the laboratory standpoint, and treated in as precise a manner as possible.

Blood Coagulation Disorders↗
PubMed1999

Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety.

BACKGROUND AND STUDY AIMS: Hemorrhage is induced in approximately 0.5-12% of endoscopic biliary sphincterotomy (ES) procedures. We prospectively investigated the risk factors for ES-induced hemorrhage and evaluated the safety as well as the effectiveness of endoscopic hemostasis. PATIENTS AND METHODS: The study included 1304 patients who underwent ES between July 1996 and June 1998. Epinephrine spray was used initially for hemostatic treatment. If bleeding persisted, an epinephrine injection was given consecutively. In patients with exposed vessels, epinephrine injection followed by alcohol injection was given. RESULTS: ES-induced hemorrhage occurred in 136 (10.4%) patients. The type of sphincterotome used (needle-knife sphincterotome, P=0.025) and the cutting speed (the so-called "zipper" cut, P = 0.049) were revealed as significant variables with regard to the occurrence of bleeding. Mild, moderate, and severe bleeding were noted in 108 (79.4%), 22 (16.2%), and six (4.4%) patients, respectively. Once bleeding occurred, patients with an associated ampullary lesion (impacted stone or cancer) or with coagulopathy were more likely to bleed profusely. Initial hemostasis was achieved in all patients. However, rebleeding occurred in eight patients who were initially classified as having moderate or severe bleeding. Finally, ES-induced hemorrhage was successfully controlled in all patients after 1-3 treatment sessions (mean 1.1 sessions). The difference in the incidence of complications between the groups treated or not treated by endoscopic hemostasis was not statistically significant. CONCLUSIONS: ES-induced hemorrhage occurred in 10% of the patients studied. The use of needle-knife sphincterotomy and the cutting speed were independent risk factors for the occurrence of bleeding. Once bleeding occurred, its severity was affected by an associated ampullary lesion (impacted stone or cancer) or coagulopathy. Endoscopic hemostasis with epinephrine and/or alcohol was effective and safe in ES-induced hemorrhage.

Biliary Tract Diseases↗
PubMed2002

Evaluation of endoscopic hemostasis in upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

BACKGROUND AND STUDY AIMS: The endoscopic hemostatic method has been introduced as a safe and effective mechanical approach to hemostasis for upper gastrointestinal bleeding related to Mallory-Weiss syndrome (MWS). However, the indications for when to use endoscopic treatment are debatable because many patients need only medical observation. The study was designed to evaluate the necessity and efficacy of endoscopic hemostasis in upper gastrointestinal bleeding related to MWS. PATIENTS AND METHODS: From July 1994 to May 2000, we conducted a clinical trial in 76 patients who were found by endoscopy to have active bleeding (I, spurting; II, oozing), protruding visible vessels (III), and/or adherent clots (IV). Two study periods can be differentiated: in the first 3 years endoscopic treatment (n = 30) was prospectively analyzed and in the final 3 years medical treatment (n = 46) was analyzed in both cases to compare the outcome in MWS bleeding II-IV. In the first study period, in addition, endoscopic treatment was randomised to an injection method, using a mixture of hypertonic saline and epinephrine (HSE) (n = 14) and a hemoclipping or band ligation method (n = 16). RESULTS: Rebleeding was observed in four of 14 patients who had received endoscopic hemostasis with HSE injection and one of 46 patients who had been managed with medical treatment. No rebleeding was found following hemoclipping or band ligation. While all rebleeding was in bleeding stigmata of the I (1) and II (4) grades, there was no rebleeding in protruding visible vessels (III) or in adherent clots (IV), regardless of treatment methods. CONCLUSIONS: Our results suggested that endoscopic hemostasis is not necessary in patients without active bleeding stigmata, and the mechanical hemostatic method is more effective than HSE injection in patients with active bleeding stigmata.

Adult↗
PubMed2003

Helicobacter pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis: a prospective single-center trial.

BACKGROUND AND STUDY AIMS: Eradication of Helicobacter pylori infection can reduce the rebleeding rate of peptic ulcer bleeding in the long term. There are few data on the influence of H. pylori on the rebleeding rate in the acute phase of bleeding however. We therefore prospectively investigated the influence of H. pylori infection on the early rebleeding rate in patients who had undergone successful endoscopic hemostasis treatment for peptic ulcer bleeding. PATIENTS AND METHODS: Between January 1996 and November 2000 all patients with peptic ulcer bleeding were evaluated consecutively. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. Bleeding activity was assessed using the Forrest classification. After successful endoscopic hemostasis all patients received omeprazole 40 mg or pantoprazole 40 mg, intravenously, twice a day for 3 days. Rebleeding episodes were recorded over 21 days following primary hemostasis. RESULTS: 344 patients were enrolled into the study. The prevalence of H. pylori infection was 62.9 %. A total of 51 patients showed rebleeding (14.8 %), of whom 31 were H. pylori-positive (60 %). There was no statistically significant difference between the H. pylori-positive and -negative patients, however. The rebleeding rate did not differ between patients with H. pylori infection alone and patients also using nonsteroidal anti-inflammatory drugs. When stratifying patients according to activity of bleeding at index endoscopy, we were also unable to find any significant influence of H. pylori infection on the outcome of Forrest class I and IIa bleedings. CONCLUSION: Based on our data, it can be concluded that H. pylori infection does not affect the early rebleeding rate in patients with peptic ulcer bleeding after successful endoscopic hemostasis.

Adolescent↗
PubMed2005

Objective benefit of a 1-day training course in endoscopic hemostasis using the "compactEASIE" endoscopy simulator.

BACKGROUND AND STUDY AIMS: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 as a training model for interventional endoscopy. Objective evidence of the benefits of training with this model has not previously been published. As part of two long-term projects, the benefits of a 1-day training course with the "compactEASIE" simulator were evaluated. MATERIALS AND METHODS: Fourteen American and 18 French gastroenterology fellows were enrolled. These fellows were participants in the intensive groups performing training in endoscopic hemostasis, with a total number of 28 fellows in New York and 36 in France. Gastrointestinal endoscopy faculty members in New York and France evaluated and timed the fellows in four disciplines to establish baseline skills (manual skills; injection and coagulation; Hemoclip application; and variceal ligation) with the compactEASIE simulator. The trainees were reevaluated after an intensive 1-day course (with two or three fellows and one instructor per station), also including preparation and assistance for each procedure. The assessment (overall and parts) was done by expert tutors using an ordinal scale ranging from 1 to 10 (1 = poorest, 10 = best), recording also mistakes and performance time. The compactEASIE simulator, equipped with an upper gastrointestinal organ package and an artificial blood perfusion system, was used as the training tool. RESULTS: A highly significant improvement ( P < or = 0.001) was observed in the performance of all endoscopic techniques. A significant reduction in performance time was also observed with three of the four endoscopic techniques. Successful hemostasis was significantly improved in two out of three techniques. CONCLUSIONS: A 1-day training course on endoscopic hemostasis using the compactEASIE simulator is capable of improving the performance of hemostasis procedures. Long-term effects of repeated training sessions are currently subject of collaborative studies in New York and France.

Clinical Competence↗
PubMed1995

Developmental hemostasis: relevance to hemostatic problems during childhood.

Congenital and acquired hemostatic disorders present during childhood. An accurate diagnosis is critically important in order to implement optimal therapy. Over the last century, several investigators have measured plasma concentrations of hemostatic components in newborns and compared the results to adult values. Clinically significant differences exist for many hemostatic components. Recently, three large studies in more than 400 healthy children have provided reference ranges for hemostatic components throughout childhood. Together, these studies provide insight into the regulation of coagulation and fibrinolysis in children in physiologic and pathologic states. Some examples of the influence of age on hemostasis are: (1) the diagnosis of some congenital factor deficiencies, based on plasma levels, can be difficult due to physiologically low values; (2) despite very low levels of many inhibitors of hemostasis, thrombotic complications are rare; (3) the interaction of anti-coagulants and thrombolytic agents is profoundly influenced by the relative immaturity of hemostasis at birth; and (4) in contrast to the risk of thrombosis, healthy infants are at risk for vitamin K deficiency bleeding due to poor transport of vitamin K across the placenta and plasma concentrations of the vitamin K dependent proteins of less than 50% of adults values. The following review discusses the age dependency of hemostasis during childhood and the effect of the physiologically immature system on the diagnosis and treatment of hemostatic disorders.

Age Factors↗
PubMed1998

Endoscopic hemostasis in exulceratio simplex-Dieulafoy's disease hemorrhage: a review of 25 cases.

BACKGROUND AND STUDY AIMS: Dieulafoy's disease is a rare cause of upper gastrointestinal tract hemorrhage. The aim of the study was to evaluate the efficacy of endoscopic hemostasis and to analyze the mortality of patients with hemorrhage due to Dieulafoy's disease. PATIENTS AND METHODS: The retrospective analysis included patients from our institution who had undergone urgent endoscopic examination of the upper digestive tract and hemostatic interventions in the period between January 1994 and December 1996. RESULTS: Twenty-five patients were examined (18 men and 7 women, average age 52.6, SD+/-15.3, range 25-78). In 20 patients endoscopic injection sclerotherapy was performed (diluted epinephrine 1:10,000 plus polidocanol 1%) and Nd:YAG laser photocoagulation in five patients. In all patients a total of 44 interventional endoscopies were carried out. Repeated endoscopic hemostasis did not prove successful in two patients (8%, 2 men), and they were treated operatively. During the postoperative period one patient died because of multiorgan failure. The total mortality rate of all patients in which endoscopic hemostasis was done was 16% (4/25). None of the 21 surviving patients had rebleeding on long-term follow-up (mean: 29.4 months). CONCLUSIONS: Endoscopic hemostasis is a major therapeutic advance in the management of Dieulafoy's disease hemorrhage. Interventional endoscopy has decreased the need for surgical management and significantly reduced mortality.

Adolescent↗
PubMed1999

The decidua regulates hemostasis in human endometrium.

Survival of the implanting human blastocyst requires that trophoblasts gain access to the maternal circulation. This is initially achieved when syncytiotrophoblasts breach endometrial capillarlies and venules. Subsequently, extravillous cytotrophoblasts penetrate the spiral arteries to induce their morphological transformation into high-flow, low-resistance vessels. This process provides the embryo with a requisite source of oxygen and nutrients, but risks decidual hemorrhage leading to abortion and abruption. Endovascular trophoblast invasion occurs within a matrix of decidualizing endometrial stromal cells. These decidual cells are temporally and spatially positioned to create a local hemostatic milieu which can counteract the threat of hemorrhage. Prior studies from our laboratory have established that decidual cells of luteal phase and pregnant endometrium express two crucial modulators of hemostasis: 1) tissue factor (TF), the primary initiator of hemostasis via factor Xa activation; and 2) plasminogen activator inhibitor type 1 (PAI-1), the fast inhibitor of the primary fibrinolytic agent, tissue type plasminogen activator. This coordinate increase in TF and PAI-1 expression provides a mechanism by which decidual cells control local hemostasis during endovascular trophoblast invasion. Cultures of human endometrial stromal cells and decidual cells isolated from first trimester endometrium demonstrate that progestins enhance TF and PAI-1 protein and mRNA expression via the induction of crucial intermediate transcription factors. Integration of these in vivo observations and in vitro studies suggest a model by which decidua acts to maintain hemostasis during implantation and placentation.

Cells, Cultured↗
PubMed2005

The platelet-function analyzer (PFA-100) for evaluating primary hemostasis.

The platelet-function analyzer, PFA-100, is a relatively novel method for rapid in vitro global evaluation of primary hemostasis. The aim of this review is to summarize the published studies reporting on the utility of the PFA-100 device as a screening tool for primary hemostasis. Data were identified by searches of the published literature, including PubMed, references from reviews and abstracts from the most important meetings on this topic. The literature data support the use of the PFA-100 as a useful screening tool for the investigation of von Willebrand's disease and other acquired and congenital intrinsic platelet function disorders. Moreover, it is useful for evaluating primary hemostasis before surgical procedures and for monitoring desmopressin therapy in both von Willebrand's disease and platelet function disorders. Given its high sensitivity, speed and simplicity of use, we conclude that the PFA-100 could replace the in vivo bleeding time as a screening test for primary hemostasis in routine clinical practice.

Blood Platelet Disorders↗
PubMed2006

Targeting coagulation factor XII provides protection from pathological thrombosis in cerebral ischemia without interfering with hemostasis.

Formation of fibrin is critical for limiting blood loss at a site of blood vessel injury (hemostasis), but may also contribute to vascular thrombosis. Hereditary deficiency of factor XII (FXII), the protease that triggers the intrinsic pathway of coagulation in vitro, is not associated with spontaneous or excessive injury-related bleeding, indicating FXII is not required for hemostasis. We demonstrate that deficiency or inhibition of FXII protects mice from ischemic brain injury. After transient middle cerebral artery occlusion, the volume of infarcted brain in FXII-deficient and FXII inhibitor-treated mice was substantially less than in wild-type controls, without an increase in infarct-associated hemorrhage. Targeting FXII reduced fibrin formation in ischemic vessels, and reconstitution of FXII-deficient mice with human FXII restored fibrin deposition. Mice deficient in the FXII substrate factor XI were similarly protected from vessel-occluding fibrin formation, suggesting that FXII contributes to pathologic clotting through the intrinsic pathway. These data demonstrate that some processes involved in pathologic thrombus formation are distinct from those required for normal hemostasis. As FXII appears to be instrumental in pathologic fibrin formation but dispensable for hemostasis, FXII inhibition may offer a selective and safe strategy for preventing stroke and other thromboembolic diseases.

Animals↗
PubMed2003

The effect of vegetarian diet, plant foods, and phytochemicals on hemostasis and thrombosis.

Ischemic heart disease (IHD) is multifactorial with a complex etiology. Conventional risk factors including serum lipids account for less than one half of future IHD events. In the past few years, novel risk factors such as hemostatic and thrombotic factors contributing to the development and progression of IHD have been explored. Typically, diet is the first line of consideration in the prevention of IHD, but very little is known about the effect of diet and nutrients on hemostasis and thrombosis. Cross-sectional studies indicate that vegetarians may have a lower concentration of certain markers of hemostasis compared with nonvegetarians. Platelet aggregation, an index of thrombosis, appears to be higher among vegetarians than nonvegetarians, perhaps because of the lower intake of long-chain n-3 fatty acids among vegetarians. Monounsaturated-fat-rich plant foods may have a protective role in hemostasis and may explain in part the lower incidence of IHD in Mediterranean countries where residents consume a diet high in monounsaturated fatty acid. Finally, certain fruits and vegetables such as soy, garlic, and purple grapes may have antithrombotic effects, which may in part be due to the phytochemicals in these foods. Although this review suggests that a plant-based diet with sufficient n-3 fatty acids and certain fruits and vegetables may have a favorable impact on hemostasis and thrombosis, the evidence is neither sufficient nor conclusive at this time to warrant specific recommendations for the public. Clearly, much remains to be done in this area of investigation.

Adult↗
PubMed1989

Physiologic mechanisms of hemostasis and fibrinolysis.

This article describes the interrelated processes and homeostatic controlling mechanisms of hemostasis and fibrinolysis. Hemostasis involves platelets, blood vessels, and coagulation proteins. Primary hemostasis is dependent on platelet adhesion, activation, secretion, and aggregation. Secondary hemostasis consists of intrinsic activation, extrinsic activation, and the common final pathway. Fibrinolysis results in clot dissolution and is initiated endogenously as plasminogen is converted to plasmin.

Blood Coagulation Factors↗
PubMed2006

Effective bone hemostasis and healing using radiofrequency and conductive fluid.

Hemostasis in bone is difficult to achieve because of the mineral content. Current techniques often are ineffective, can have systemic effects, or leave residual material in the wound. Our hypotheses were that a wand device coupling radiofrequency energy with a cooling conductive saline solution, applied topically to bone, could produce superior hemostasis compared with conventional electrocautery or no treatment, and not impede bone healing. Immediate hemostasis and subsequent bone healing for 6 and 12 weeks were evaluated in an iliac crest ostectomy (cancellous bone) and a drilled tibia defect (cortical bone) sheep model. Outcome variables were amount and intensity of bleeding, serial radiography, quantitative computed tomography, histology and mechanical testing. Control of bleeding was nearly complete (93%) and greater with the radiofrequency/saline treatment compared with electrocautery (56%) or no treatment (0%) in cancellous bone and cortical bone. Electrocautery induced surface char (black carbon debris) that could be seen at 6 and 12 weeks. There were no differences in bone healing between the radiofrequency and electrocautery device applications or untreated bone. At 12 weeks, all healing tibiae defects were as strong as undrilled tibiae. This may be an effective method to produce rapid hemostasis in bone without char or healing complications.

Animals↗