Review of topical gelatin‐based haemostatic agents; an insidious culprit of intraoperative anaphylaxis?

2021 ◽  
Author(s):  
Roland Z. White ◽  
Lachlan Kerr ◽  
Tyler J. White ◽  
Matthew J. Sampson
Keyword(s):  
Haemostatic Agents

The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures

2012 ◽  
Vol 8 (2) ◽  
pp. 125
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe ◽  
◽  
Keyword(s):  
Surgical Procedures ◽  
Ventricular Assist Device ◽  
Cardiac Transplantation ◽  
Cardiac Surgical Procedures ◽  
High Risk Group ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Refractory Heart Failure ◽  
Haemostatic Agents

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

scholarly journals Prophylactic use of dural tenting sutures in elective craniotomies in adults—is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Przemysław Kunert ◽  
Łukasz Przepiórka ◽  
Jan Fortuniak ◽  
Karol Wiśniewski ◽  
Ernest Jan Bobeff ◽  
...  
Keyword(s):  
Study Protocol ◽  
Intervention Group ◽  
Cerebrospinal Fluid Leak ◽  
Evidence Based ◽  
Extradural Haematoma ◽  
Haemostatic Agents ◽  
Need To Evaluate ◽  
Prophylactic Use ◽  
Double Blinded ◽  
The Impact

Abstract Background In the early days of neurosurgery, extradural haemorrhages (EDHs) contributed to a high mortality rate after craniotomies. Almost a century ago, Walter Dandy reported dural tenting sutures as an effective way to prevent postoperative EDH. Over time, his technique gained in popularity and significance to finally become a neurosurgical standard. Yet, several retrospective reports and one prospective report have questioned the ongoing need for dural tenting sutures. Dandy’s explanation that the haemostasis observed under hypotensive conditions is deceiving and eventually causes EDH may be obsolete. Today, proper intra- and postoperative care, including maintenance of normovolemia and normotension and the use of modern haemostatic agents, may be sufficient for effective haemostasis. Thus, there is a fundamental need to evaluate the necessity of dural tenting sutures in a solid, unbiased, evidence-based manner. Methods This study is designed as a randomised, multicentre, double-blinded, controlled interventional trial with 1:1 allocation. About one half of the participants will undergo craniotomy without dural tenting sutures and will be considered an intervention group. The other half will undergo craniotomy with these sutures. Both groups will be followed clinically and radiologically. The primary outcome is reoperation due to extradural haematoma. Secondary outcomes aim to evaluate the impact of dural tenting sutures on mortality, readmission risk, postoperative headaches, size of extradural collection, cerebrospinal fluid leak risk and the presence of any new neurological deficit. The study protocol follows the SPIRIT 2013 statement. Discussion It is possible that many neurosurgeons around the globe are tenting the dura in elective craniotomies which brings no benefit and only extends the operation. Unfortunately, there is not enough data to support or reject this technique in modern neurosurgery. This is the first study that may produce strong, evidence-based recommendations on using dural tenting sutures. Trial registration, ethics and dissemination The Bioethics Committee of the Medical University of Warsaw approved the study protocol (KB/106/2018). The trial is registered at http://www.clinicaltrials.gov (NCT03658941) on September 6, 2018. The findings of this trial will be submitted to a peer-reviewed neurosurgical journal. Abstracts will be submitted to relevant national and international conferences. Trial status Protocol version and date: version 1.5, 14.01.2020 First recruitment: September 7, 2018 Estimated recruitment completion: September 1, 2021

Haemostatic Agents

BMJ ◽  
1949 ◽  
Vol 2 (4624) ◽  
pp. 425-425
Author(s):  
R. B. Scott
Keyword(s):  
Haemostatic Agents

scholarly journals Design of New-Generation Usable Forms of Topical Haemostatic Agents Containing Chitosan

Molecules ◽  
2017 ◽  
Vol 22 (12) ◽  
pp. 2240 ◽  
Author(s):  
Dorota Zielińska ◽  
Marcin Struszczyk ◽  
Longina Madej-Kiełbik ◽  
Edyta Chmal-Fudali ◽  
Magdalena Kucharska ◽  
...  
Keyword(s):  
Haemostatic Agents ◽  
New Generation

Haemostatic agents for topical use

1977 ◽  
pp. 142-144
Author(s):  
M. Verstraete
Keyword(s):  
Haemostatic Agents

scholarly journals Imaging appearance on CT post laparoscopic Roux-en-Y gastric bypass using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia

2019 ◽  
Vol 5 (3) ◽  
pp. 20180111
Author(s):  
Mark Page ◽  
James Drummond ◽  
Mark Magdy ◽  
John Vedelago ◽  
Vytauras Kuzinkovas
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Surgical Technique ◽  
Fibrin Glue ◽  
Subsequent Treatment ◽  
Open Approach ◽  
Internal Hernias ◽  
Haemostatic Agents ◽  
Petersen’S Hernia ◽  
Post Bariatric Surgery

Imaging post bariatric surgery is becoming more common over the past decade due to increasing incidence of obesity in the population and subsequent treatment. In recent years, the use of topical haemostatic agents and bioabsorbable prostheses has increased leading to higher likelihood of encountering these agents on post-operative imaging. Imaging in the post-operative period is occasionally performed to assess for complications such as obstruction, leak and abscess formation. Familiarity with these agents is crucial in preventing incorrect diagnosis. Laparoscopic Roux-en-Y gastric bypass (RYGB) is favoured over the open approach as it is safer and more effective, with a mortality rate of 0.5% and morbidity around 7–14 %. The main cause of late post-RYGB complications is the development of internal hernias such as a Petersen’s hernia. During the procedure, a space between the alimentary loop of the small bowel and the transverse mesocolon is created and is called the Petersen’s defect. Subsequently, a part of the small bowel can herniate through this orifice. As this operation is becoming more common, the incidence of internal herniation has been increasing. This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia and involves a laparoscopic RYGB using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia.

scholarly journals Ultrasound appearance of SURGICEL® Absorbable Hemostat (oxidised cellulose) following laparoscopic resection of a splenic cyst – A potential diagnostic peril

Ultrasound ◽  
2020 ◽  
Vol 28 (2) ◽  
pp. 124-130
Author(s):  
Paul Jenkins ◽  
Luke Rogers ◽  
Mark Coleman ◽  
Simon Freeman
Keyword(s):  
Computed Tomography ◽  
Surgical Procedure ◽  
Laparoscopic Resection ◽  
Surgical Intervention ◽  
Diagnostic Error ◽  
Splenic Cyst ◽  
Surgical Team ◽  
Critical Importance ◽  
Tissue Phantom ◽  
Haemostatic Agents

We present the case of a 14 year old who underwent laparoscopic marsupialisation of a splenic cyst. Postoperative ultrasound demonstrated an echogenic collection in the surgical bed that was initially misdiagnosed as an infected collection/abscess due to its sonographic appearances but was finally correctly identified as haemostatic material that had been packed into the surgical cavity. We subsequently constructed a tissue phantom containing a compressed ball of SURGICEL (r) Absorbable Hemostat and demonstrated that it showed identical sonographic appearances. Haemostatic agents such as oxidised cellulose are often packed within the operative bed to control microvascular haemorrhage. These agents can be observed on a variety of postoperative imaging modalities, in particular ultrasound and computed tomography, and may cause diagnostic error. The critical importance of understanding the details of the surgical procedure and effective communication between the surgical team and ultrasound practitioner is emphasised to minimise the risk of misdiagnosis and unnecessary further imaging and radiological/surgical intervention.

Recent developments in topical thrombins

2009 ◽  
Vol 102 (07) ◽  
pp. 15-24 ◽  
Author(s):  
Thomas L. Ortel ◽  
Craig M. Kessler
Keyword(s):  
Human Plasma ◽  
Excessive Bleeding ◽  
Bovine Thrombin ◽  
Bovine Plasma ◽  
Haemostatic Agents ◽  
Coagulation Proteins ◽  
Equivalent Efficacy ◽  
Human Thrombin ◽  
Recent Developments ◽  
Surgical Bleeding

SummaryManaging blood loss is part of the surgeon’s responsibility during surgical procedures, and a variety of therapeutic strategies are available to help accomplish this. Topical haemostatic agents are among the agents used to control surgical bleeding and locally arrest blood flow. Bovine thrombin is a commonly used topical haemostatic agent; however, its use has been associated with potential risks, including well-documented cases of antibodymediated coagulopathy. This coagulopathy develops as a consequence of antibody formation directed against bovine thrombin, other bovine coagulation proteins, and their human orthologs. The fact that a coagulopathy can result in association with the use of bovine plasma-derived thrombin preparations prompted the FDA to require pharmaceutical companies to place a black-box warning in their prescribing information for products containing bovine plasma-derived thrombin. Recently, human plasma-derived thrombin and recombinant human thrombin have been approved by the FDA with the expectation that they will be less immunogenic than the bovine-derived product. In clinical studies, purified human plasma-derived thrombin and recombinant thrombin have demonstrated equivalent efficacy and safety, with improved immunogenicity profiles compared with bovinederived thrombin agents. Well-designed and adequately powered clinical trials should be conducted to indicate whether human thrombin products would improve the risk-benefit and costbenefit profiles for surgeries complicated by excessive bleeding.

Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1065-1092 ◽  
Author(s):  
I Z Iqbal ◽  
G H Jones ◽  
N Dawe ◽  
C Mamais ◽  
M E Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Care Setting ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Economic Effects ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Nasal Pack ◽  
Appropriate Care ◽  
Haemostatic Agents

AbstractBackground:The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.Method:A systematic review of the literature was performed using standardised methodology.Results:Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.Conclusion:Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.

Blood product therapy in the ICU

2016 ◽  
Author(s):  
Lirong Qu ◽  
Darrell J. Triulzi
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Large Body ◽  
Invasive Procedure ◽  
Transfusion Practice ◽  
Transmission Risk ◽  
Haemostatic Agents ◽  
Circulatory Overload ◽  
Red Cell Transfusion ◽  
Transfusion Guidelines

Transfusions are among the most common medical procedures in the intensive care unit. Several randomized controlled trials (RCT) indicate that restrictive red cell transfusion practice using a haemoglobin of <7g/dL is safe in critically-ill patients. Although similar RCT are not available for plasma or platelet transfusion guidelines, a large body of observational studies suggest that plasma transfusion for an invasive procedure has not been shown to be of benefit in patients with INR <2.0. Similarly, in thrombocytopenic patients, the target platelet count for bleeding or for an invasive procedure is 50,000/µl. Viral transmission risk has become exceedingly low. Other risks such as transfusion-associated circulatory overload and, to a lesser extent, transfusion-related acute lung injury, are much more common. Storage of red cells does not seem to be associated with adverse clinical outcomes. Alternatives using haemostatic agents, salvaged blood, and adherence to evidence-based transfusion guidelines probably reduce the need for transfusion in critically-ill patients.

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