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PubMed1976

Prospective evaluation of hemostatic techniques for liver injuries.

The methods of hemostasis used for liver injuries were evaluated prospectively in 637 patients treated at Detroit General Hospital during a 5-year period. Variables evaluated included severity of injury, presence or absence of bleeding, and methods of hemostasis, The liver injury was either not bleeding or was controlled by temporary pack compression during laparotomy in 325 patients: none of these patients, including the 284 in whom no hemostatic procedure was used, rebled postoperatively. Active bleeding at laparotomy was directly related to the severity of liver injury, and required some hemostatic procedure in 312 patients. The methods of hemostasis were liver sutures (244 patients), nonanatomic resection (30 patients), anatomic resection (21 patients), hepatic artery ligation (nine patients), hepatotomy with intraparenchymal vascular control (five patients), and temporary internal pack with later re-operation (three patients). Rebleeding occurred in eight of the 243 patients who survived (seven after liver sutures and one after nonanatomic resection) and four required re-operation for control of bleeding. Sixty-nine patients with active bleeding died. Death on the table in 38 patients was related primarily to uncontrolled bleeding from liver and major vessel injury. Postoperative rebleeding from the liver occurred in 14 of 31 patients who died after surgery: following initial control by liver sutures (seven patients); anatomic resection (four patients); and hepatic artery ligation (three patients). There was no apparent relationship between any hemostatic procedure and the subsequent appearance of the hepatic ischemia or parahepatic abscess. Based on this experience, the merits and detriments of individual hemostatic procedures are presented.

Hemorrhage↗
PubMed1980

Collagen fibers as a fleece hemostatic agent.

The hemostatic efficacy of collagen fibers as a fleece hemostatic agent (CFH) is compared with the efficacy of three commercially available agents: collagen powder (Avitene), absorbable gelatin sponge, and oxidized cellulose. Identical quantities of the four materials were applied to identical multiple spleen incisions in five dogs; CFH and collagen powder proved three times as effective as the other two mateials. CFH and collagen powder were then compared with regard to hemostatic efficacy, handling characteristics, and tissue reaction. Different weights of the materials were applied to multiple spleen lacerations in 12 dogs and spleen avulsions in 12 dogs. The hemostatic efficacy of the materials was similar, but CFH was superior with regard to handling characteristics and tissue reaction. Another experiment, with six pigs, showed that CFH can be successfully sutured as a patch to profusely bleeding lacerations of the spleen, liver, and kidney.

Animals↗
PubMed1981

Experimental and clinical experiences with collagen fleece as a hemostatic agent.

We report on our laboratory and clinical experience with a new hemostatic agent made of collagen fibers and existing in the form of a loose or compressed fleece. This material was tested in two independent bleeding models on eight dogs and 21 patients. Partially compressed collagen fleece showed significantly higher hemostatic effectiveness when compared to loose fleece. This was demonstrated by gravimetric determinations of blood loss in dogs with split-thickness skin excisions and by measuring the blood loss and time of bleeding after an excision 0.5 cm deep and 4 cm wide of the edge of the spleen. The handling of partially compressed hemostatic fleece was found superior to loose or fully compressed fleece. Clinical cases included patients with liver lacerations and retroperitoneal bleeding. Collagen fleece, partially compressed, proved to be an effective topical hemostatic agent when applied directly with pressure to a bleeding surface and when folded and sutured against a bleeding surface. Postoperative injection rate was not increased nor was foreign body reaction demonstrated. The material was extremely easy to apply, did not adhere to gloves or instruments, and could be cut or molded to any desired shape.

Adolescent↗
PubMed2003

Migration of intracranial hemostatic clip into the lumbar spinal canal causing sacral radiculopathy: a case report.

STUDY DESIGN: A case report. OBJECTIVES: A case of spontaneous migration of intracranial hemostatic clip into the lumbar spinal canal causing a sacral radiculopathy and severe low back pain was presented. SUMMARY OF BACKGROUND DATA: Only five cases have been reported in the literature. The first report was described by Oyesiku in 1986; thereafter, four cases have been reported. This serves as the first report clearly describing the relationship between the migrated site of a foreign body and neurologic symptom, as well as achieving a remission of symptom after surgical extirpation. METHODS: A patient who had received hemostatic clips to the aqueductal stenosis 31 years ago presented with low back pain and sacral radiculopathy. Plain radiography, myelography, and subsequent CT revealed that a metal foreign body was located in the subarachnoid space at L4 level. Laminectomy of L4 and extirpation of the foreign body were performed. RESULTS: The foreign body was a hemostatic clip made of cobalt-based alloy that had been applied during the previous intracranial surgery. The clip irritated the adjoined intrathecal nerve root and possibly caused the adhesive arachnoiditis. All symptoms completely disappeared after the extirpation. CONCLUSIONS: An uncommon case of an intracranial hemostatic clip migrating into the lumbar subarachnoid space as well as causing sacral radiculopathy was reported. The surgical extirpation provided an excellent clinical outcome.

Foreign-Body Migration↗
PubMed2004

Evaluation of microporous polysaccharide hemospheres as a novel hemostatic agent in open partial nephrectomy: favorable experimental results in the porcine model.

PURPOSE: Microporous polysaccharide hemospheres (MPH, Medafor, Minneapolis, Minneapolis) are a novel hemostatic agent made from purified plant starch. MPH activates the clotting cascade and hyperconcentrates platelets and coagulation proteins, while enhancing a hemostatic plug. We evaluated the hemostatic efficacy of MPH compared with standard surgical technique in a porcine open partial nephrectomy model. MATERIALS AND METHODS: Standardized lower pole partial nephrectomy was consecutively performed in each kidney of 12 female pigs. Each pig was randomized to 2 groups, namely treatment with MPH application or control with the conventional surgical technique (oxidized cellulose with bolster sutures). The right kidney was harvested 1 half-hour after hemostasis was achieved and the left kidney was harvested after 7 days. RESULTS: Mean animal and resected renal tissue weight were comparable. Ischemic and hemostasis times were significantly decreased in the MPH treated group (2.67 and 4.67 minutes, respectively) vs the control group (8.33 and 7.75 minutes, respectively) (each p = 0.004). Blood loss was equivocal (0.88 gm in the treatment group vs 2.09 gm in the control group, p = 0.07). No hemostatic complications were noted in either group. No evidence of residual foreign material was found in the MPH group at 1 week. CONCLUSIONS: MPH provided rapid, effective and durable hemostasis in the porcine open partial nephrectomy model. Additional experimental and clinical evaluation is warranted to define the role of MPH assisted partial nephrectomy in humans.

Animals↗
PubMed2006

Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury.

BACKGROUND: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. METHODS: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. RESULTS: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100% in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43%, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10 degrees C. No histologic evidence of tissue necrosis was noted in this experiment. CONCLUSIONS: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.

Animals↗
PubMed1999

[Hemostatic effect of a novel sheeted fibrin adhesive agent, TO-193, on experimental incision models].

TO-193 (TachoComb) is a new fibrin adhesive agent that consists of a collagen sheet coated with fibrin glue. We compared the hemostatic effect of TO-193 in several experimental models with Beriplast P as a fibrin adhesive agent, Avitene and Novacol as a microfibrillar collagen hemostat, and a sponge-like collagen sheet as the constitutional parts of TO-193. In the in vitro bleeding model in which blood leaks out through cotton cloth, the pressure of TO-193 when blood leakage was observed was higher than those of Beriplast P, Avitene, Novacol and the collagen sheet, indicating that TO-193 possessed a strong adhesive effect on the bleeding surface. On the kidney resection surface, TO-193 showed a more potent adhesive effect than those of Beriplast P and the collagen sheet, suggesting that TO-193 has a potent hemostatic effect. In the liver resection, TO-193 significantly reduced the bleeding volume compared with that of Novacol in normal rats. Furthermore, the bleeding volume of TO-193 was about half that of Beriplast P and equivalent to that of Novacol even in anticoagulant-treated rats. From these data, it is expected that TO-193 would be a valuable hemostatic agent for clinical use since TO-193 possesses a potent adhesive ability on the bleeding resection surface and would certainly stop bleeding in both patients with normal coagulation and those with a low blood coagulation condition.

Animals↗
PubMed2006

Short-term hemostatic safety of strontium ranelate treatment in elderly women with osteoporosis.

BACKGROUND: Strontium ranelate offers significant clinical benefits in terms of efficacy, tolerability, and ease of administration in the treatment of postmenopausal osteoporosis. However, there are some data revealing an association between strontium ranelate treatment and increased incidence of venous thromboembolism (VTE), suggesting possible adverse prothrombotic effects of the drug. OBJECTIVE: To assess the effect of strontium ranelate treatment on primary hemostasis, secondary hemostasis, and the natural anticoagulant defense system, together with prothrombotic markers, in elderly women with osteoporosis. METHODS: This study was designed in a prospective manner. Thirty-five elderly women diagnosed with osteoporosis were included. During a 2 month treatment period, participants received strontium ranelate 2 g. Platelet Function Analyzer-100 (PFA-100) in vitro bleeding time was performed to depict primary hemostasis. Secondary hemostatic parameters including prothrombin time, international normalized ratio, activated partial thromboplastin time, anti-cardiolipine immunoglobulin (Ig) M and IgG, antiphospholipid IgM and IgG, protein C, protein S, antithrombin III, lupus anticoagulant, fibrinogen, thrombin, activated protein C resistance, and plasma levels of d-dimer were assessed. These parameters were tested before and after 2 month treatment with strontium ranelate. RESULTS: Mean +/- SD age of the patients was 72.82 +/- 5.69 years. After 60 days of treatment, there was no statistically significant prolongation in PFA-100 in vitro bleeding time and no statistically significant change in the critical hemostatic parameters in patients receiving strontium ranelate that led to discontinuation of the treatment. None of the subjects developed clinical VTE during the 2 month period of strontium ranelate treatment. CONCLUSIONS: The hemostatic safety of strontium ranelate in the elderly population with osteoporosis was shown over 2 months of treatment; however, its long-term hemostatic safety should be evaluated further.

Aged↗
PubMed1998

[Hemostatic and structural effects of the lyophilized cellulose sponge].

Hemostatic effects of oxidized cellulose (Surgicel) are well known. Based on a possible similar effect of a sponge obtained after lyophilization of biosynthetic cellulose, two different experimental studies were planned. Phase I-Pieces of cellulose sponge were inserted into small provoked cortical wounds of twelve dogs. The time elapsed to obtain bloodstill after cortical damage and application of cellulose was observed in every dog, searching to detect any possible hemostatic effect of the material. The animals were sacrificed after 7, 30 and 90 days. An average time of 1 minute was elapsed until bleeding control was achieved. No clinical adverse effect was noticed. Microscopy showed histiocytic and mild foreign body reaction at 7 days, which diminished at 30 days. Almost no reaction surrounded the implant at 90 days. Lyophilized cellulose has a peculiar eosinophilic appearance, composed by thin irregular filaments which diminished their thickness with the time. At 90 days only sparse irregular cellulose filaments could be detected. Phase II-Small equal sponge fragments were inserted in the liver of twelve rats and observed 7, 30 and 90 days. At autopsy, small peritoneal adhesions were noticed at 30 and 90 days. Microscopy showed intense histioplasmocytic and foreign body reaction in all animals mainly at 7 days. In two animals, refringent intracellular cellulose particles were evident inside giant foreign body cells after 90 days. This fact evidences that cellulose can be reabsorbed by phagocytic phenomena when implanted in mammalians. A comparative group with other hemostatic material and the same method must be done to clarify the issue of hemostatic effects of this membrane.

Animals↗
PubMed1998

[Host-guest molecule interaction mechanism of hemostatics with liposomes and red blood cells studied with fluorescence polarimetric method].

The supermolecule compounds of adrenobazone, p-aminomethylbenzoic acid, vitamin K1, 6-amino caproic acid with liposomes and red blood cells were studied by fluorescence polarimetric method. The mechanisms of formation of the supermolecule compounds were examined by fluorescence probe of the link of 1,6-dipheny-1,3,5-hexatriene (DPH) with liposomes which were taken as a model of blood cells. The interaction mechanism of hemostatics with red blood cells was described according the quantitative relationship between polarization value (P) and the microviscosity [formula: see text]. The result showed that the acting force between hemostatics and liposomes or that between hemostatics and red blood cells were mainly supermolecular acting force. The acting force between vitamin K1 and cytomembrane is hydrophobic force and those between adrenobazone, p-aminomethylbenzoic acid, or 6-amino caproic acid and cytomembrane are hydrogen bond or electrostatic force. Under the same drug concentration, all of the four haemostatics can reduce the fluidity of the cell membrane, which benefits blood coagulation. The binding ways of hemostatics with red blood cells was also discussed.

4-Aminobenzoic Acid↗
PubMed2005

A comparision of the hemostatic effects of notoginseng and yun nan bai yao to placebo control.

INTRODUCTION: We previously demonstrated the hemostatic effects of notoginseng using a rat bleeding model. Yun-Nan-Bai-Yao is a proprietary product for external use in China to treat bleeding but the hemostatic effects have not been proven. This study was conducted to compare the hemostatic effects of notoginseng to that of Yun-Nan- Bai-Yao and placebo control. METHODS: Rats (n = 37) were randomized into 3 groups and their tails were transected 5mm from the tip in this blinded investigation. Group 1 received placebo (wheat flour, n = 17), group 2 received notoginseng (n = 10) and group 3 received the Yun-Nan-Bai-Yao (n = 10). The total bleeding time was determined and compared among groups. RESULTS: Beeding time in minutes was 29.7% and 22.3% lower in the notoginseng and Yun-Nan-Bai-Yao groups than the placebo group (p < 0.001 and p < 0.001, respectively). No significant difference was found between the two active groups (p = 0.418). CONCLUSIONS: When applied externally, both notoginseng and Yun-Nan-Bai-Yao provide appreciable hemostatic effects compared to placebo.

Analysis of Variance↗
PubMed1991

Hemostatic agents. Adjuncts to control bleeding.

1. Allergic reactions can occur with the use of topical hemostatic agents. 2. Some hemostatic agents may be used in combination to provide more effective hemostasis (eg, thrombin and Gelfoam). 3. Documentation should be made of any hemostatic agent left in situ at the time of closure. 4. Use of topical hemostatic agents is generally contraindicated in contaminated wounds.

Education, Nursing, Continuing↗
PubMed1986

[Experimental study on brain tissue of microfibrillar collagen hemostat (Avitene)].

Microfibrillar collagen hemostat (Avitene) is a new absorbable topical hemostatic agent, of which hemostatic mechanisms are adhesion to the bleeding site and platelet aggregation. Avitene was used to obtain hemostasis and compared with Gelfoam or Oxycel in the injured cerebral cortex in a rabbit. The animals were killed and the lesions were examined grossly and microscopically to evaluate its biocompatibility in the cerebral cortex. Histopathological examinations revealed that Avitene was biocompatible with cerebral cortex in a rabbit. Electroencephalographies did not show the epileptogenic focus when Avitene was applied on the cerebral cortex in a rabbit. It has been applied for the bleeding during surgery for several years. Its effectiveness of hemostasis has been well known. This study indicated that Avitene is very effective and safe to use as a topical hemostatic agent during craniotomy in a rabbit. Therefore, this agent may be useful in a patient with minor and diffuse bleeding in the neurosurgical field.

Animals↗
PubMed1984

Hydrogen peroxide as a topical hemostatic agent.

Many research efforts have been directed toward enhancing the bone-cement interface of total joint arthroplasties. Hemostatic agents have been popularized as effective means of retarding the development of potentially harmful debris interposition adjacent to, and blood lamination patterns within, the methylmethacrylate. The hemostatic effectiveness of hydrogen peroxide was tested on six metaphyseal bone beds in ten mongrel dogs: three sites were treated with hydrogen peroxide and three were saline-treated control sites. The hemostatic effect of the treatments was determined by comparing blood loss per unit area per minute before and after application of the test solutions. The results indicate that hydrogen peroxide is an effective hemostatic agent and reduces the amount of blood and debris trapped within the trabecular bone methylmethacrylate interface.

Administration, Topical↗
PubMed1999

Hemostatic molecular markers before the onset of disseminated intravascular coagulation.

We retrospectively measured various hemostatic markers in 240 patients with disseminated intravascular coagulation (DIC) before the onset of DIC and in 110 non-DIC patients, and examined their usefulness for the diagnosis of pre-DIC. Changes in prothrombin time ratio and fibrinogen levels were not significant before the onset of DIC. The plasma levels of fibrinogen and fibrin degradation products before the onset of DIC were increased and the platelet count was gradually reduced in nonleukemic patients; these changes were already significant in the non-DIC state. The plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were increased before the onset of DIC. In leukemic patients, the plasma levels of sFM on day 5, those of TAT on day 3, and D-dimer on day 1, were significantly increased before the onset of DIC. The levels of most hemostatic markers 7 days before the onset of DIC were not different from those observed in the non-DIC state. In nonleukemic patients, only D-dimer, sFM, and TAT levels were significantly increased 7 days before the onset of DIC compared with values in the non-DIC state. The positive rate of hemostatic markers for the diagnosis of DIC, TAT, and PPIC were high during the pre-DIC and non-DIC groups. The plasma levels of sFM and D-dimer were low in non-DIC and increased gradually during the pre-DIC state. These findings suggest that hemostatic molecular markers such as sFM, D-dimer, and TAT are useful for the diagnosis of pre-DIC, although their cutoff values were different among various diseases.

Antifibrinolytic Agents↗
PubMed2004

Hemostatic markers and the sepsis-related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit.

We investigated the correlation between disseminated intravascular coagulation (DIC) score and hemostatic parameters and sepsis-related organ failure assessment (SOFA) score with clinical outcome of patients with DIC in an intensive care unit (ICU). The SOFA score was markedly elevated in patients with DIC relative to patients without DIC and significantly higher in non-survivors than in survivors. Abnormalities in almost all hemostatic parameters were significant in patients with DIC, but there was no significant difference in almost all hemostatic parameters between survivors and non-survivors. However, plasma antithrombin (AT) levels were significantly lower in non-survivors than in survivors. Soluble fibrin (SF) and tissue type plasminogen activator (tPA)-plasminogen activator inhibitor-I (PAI-I) complex correlated significantly with the SOFA score, whereas AT levels correlated significantly and negatively with the SOFA score. We conclude that the SOFA score is useful for predicting outcome in DIC patients in the ICU, and that hemostatic parameters, especially plasma AT levels, are also useful markers for organ failure and clinical outcome.

Antithrombins↗
PubMed2004

Association of functional thrombin-activatable fibrinolysis inhibitor (TAFI) with conventional cardiovascular risk factors and its correlation with other hemostatic factors in a Spanish population.

Our aim was to determine the associations of functional thrombin-activatable fibrinolysis inhibitor (TAFI) levels in plasma with conventional cardiovascular risk factors, sex and age, and possible correlations with other hemostatic factors in a Spanish population. We included 303 individuals from a Spanish population. Hemostatic factors such as von Willebrand Factor, VII ag, VIIIc, XIc, XIIc, APCR, protein S, protein C, antithrombin, fibrinogen, and t-PA antigen were assayed. The functional TAFI assay was based on the activation of plasma TAFI with thrombin-thrombomodulin, and the measure of TAFIa activity on the hippuryl-Arg substrate. There were no statistical differences in mean values of functional TAFI among the various female age groups or among the different male age groups, with or without cardiovascular risk factors. Only women younger than 30 years of age showed lower levels of functional TAFI compared to older women. No differences were found among men of different ages. Adjusted for sex and age, hemostatic factors did not show a correlation with functional TAFI levels in plasma. Women with hypercholesterolemia showed higher levels of TAFI; other conventional cardiovascular risk factors did not modify functional TAFI levels either in men or in women. We also found no correlation of functional TAFI levels related to any other hemostatic factors.

Adult↗
PubMed1982

A comparison of hemostatic agents in microvascular surgery.

The hemostatic abilities of oxidized cellulose, gelatin powder, microfibrillar collagen, and expanded polytetrafluoroethylene cuffs were compared on anastomoses of the femoral vessels in rats. The intraoperative hemostatic time and patency were recorded. Vessels that were patent intraoperatively were examined at various intervals postoperatively to determine patency and to detect the development of abnormalities, and specimens for examination under a scanning electron microscope were obtained. Microfibrillar collagen was found to be superior in maintaining patency and in ease of use. The PTFE cuffs demonstrated the shortest hemostatic times, but they produced distortion of the vessels several weeks after surgery. The authors conclude that microfibrillar collagen is the best overall hemostatic agent and have continued to use it experimentally and clinically with no complications.

Animals↗