Hemostatic Agent
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First responders are sometimes confronted with external uncontrolled haemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agents were developed to try to face these situations. Their application was... more
First responders are sometimes confronted with external uncontrolled haemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agents were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic perineal trauma for whom the use of a haemostatic bandage QuikClot ACS+™ (Z-Medica) seemed to us particularly useful in prehospital setting.
Background This study aimed to prospectively quantify the frequency of serious bleeding during pelvic surgery for locally advanced or recurrent rectal cancer and review the surgical methods used to control this. Methods Consecutive cases... more
Background This study aimed to prospectively quantify the frequency of serious bleeding during pelvic surgery for locally advanced or recurrent rectal cancer and review the surgical methods used to control this. Methods Consecutive cases of pelvic surgery for curative resection of locally advanced or recurrent rectal cancer were prospectively evaluated over a nine-month period. The procedures undertaken included multivisceral resections, sacrectomies or ultra-low anterior resections. Multivisceral resections were defined as pelvic exenterations, extra-levator abdominoperineal resections (ELAPER) and recurrent anterior resections. The primary endpoint was the proportion of patients sustaining major blood loss, defined as ≥1,000 ml. The secondary endpoint was the blood transfusion rate. Haemostatic adjunct use was recorded. Results Twenty-six patients underwent surgery, comprising 11 pelvic exenterations, 3 ELAPERs, 1 recurrent anterior resection, 5 abdominosacral resections and 6 ultra-low anterior resections. The median intraoperative blood loss was 1,250 ml with 53.8 % of the patients sustaining a loss ≥1,000 ml. Fifty per cent of patients required a blood transfusion within 24 h, and one or more haemostatic adjuncts were necessary in 50 % of the cases. Adjuncts used included a fibrinogen/thrombin haemostatic agent in 38.5 % of patients, temporary intraoperative pelvic packing in 11.5 % of patients and preoperative internal iliac artery embolization in 7.7 % of patients. Conclusions This patient group is at a high risk of intraoperative haemorrhage, and such patients are high consumers of blood products. Haemostatic adjunct use is often necessary to minimize blood loss. We describe our local algorithm to assist in the assessment and intraoperative management of these challenging cases.
Objectives/Hypothesis: Bleeding during endoscopic sinus surgery and open surgeries can easily obstruct the surgeons' field of view and increase morbidity and risk of intraoperative complications. Intraoperative bleeding could potentially... more
Objectives/Hypothesis: Bleeding during endoscopic sinus surgery and open surgeries can easily obstruct the surgeons' field of view and increase morbidity and risk of intraoperative complications. Intraoperative bleeding could potentially be addressed by a hemostatic agent that safely disperses itself through the escaping blood. We tested the safety and efficacy of a self-propelling formulation of thrombin and tranexamic acid (SPTT) in stopping bleeding in a paranasal sinus injury and in an open surgical carotid injury sheep model. Study Design: Interventional animal study. Methods: SPTT was tested in the sinonasal space following endoscopic injury to the inferior turbinate of six sheep, and to the common carotid artery following open surgical injury in eight sheep. In the nasal cavity, bleeding time and local inflammation were measured and compared to plain gauze. Following carotid arteriotomy, successful hemostasis and markers of thrombosis and coagulopathy were compared to Floseal. Results: SPTT significantly decreased bleeding times in the sinonasal space compared to plain gauze (mean difference 5 3.8 minutes, P 5 .002). All of the carotid bleeds (100%) were successfully controlled with SPTT after 10 minutes of application under pressure, compared to 25% with Floseal. No adverse events were noted, and there was no evidence of thromboembolism. Conclusions: SPTT significantly reduced bleeding time in a sheep model of surgical sinus bleeding and successfully stopped bleeding following catastrophic carotid artery injury, with no adverse events observed.
A wide variety of topical hemostatic agents, sealants, and tissue adhesives is currently available. Knowledge of the mechanism of action of each of them is essential for choosing the ideal agent for each type of hemorrhage. Hemostatic... more
A wide variety of topical hemostatic agents, sealants, and tissue adhesives is currently available. Knowledge of the mechanism of action of each of them is essential for choosing the ideal agent for each type of hemorrhage. Hemostatic agents are divided into two groups according to mechanism of action: a) active, which activates platelets b) passive or mechanical, which promotes blood absorption, increase in volume, and creates pressure on the site of the bleeding. Active agents can be used in coagulopathies and use human plasma components like thrombin and fibrin. As such, they can transmit viral diseases and are more expensive. Mechanical agents, because they stop the bleeding due to volume increase cannot be used in confined areas. This article considers the characteristics of various hemostatic agents. RESUMO Existe disponível, atualmente, grande variedade de agentes hemostáticos locais, ve-dantes e adesivos tissulares. O conhecimento do mecanismo de ação de cada um deles é primordial para a escolha do agente ideal para cada tipo de hemorragia. Os agentes hemostáticos são divididos em dois grupos, de acordo com seus mecanismos de ação: a) ativos-os ativadores das plaquetas; b) passivos ou mecânicos-promotores da absor-ção do sangue, aumentando o seu volume e pressionando o local do sangramento. Os agentes ativos podem ser usados nas coagulopatias, utilizam componentes do plasma humano como trombina e fibrina e, por isto, podem transmitir doenças virais e são mais dispendiosos. Os agentes mecânicos, por criarem uma barreira ao sangramento devido ao aumento de volume, não podem ser usados em áreas confinadas. Neste artigo são feitas considerações sobre as características dos vários agentes hemostáticos.
CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding Large Font Normal Small fonts SMJ Mortazavi1,2, A Tavasoli3, M Atefi2, N Tanide4, N Radpey1, P Roshan-shomal1, H Moradi2, S Taeb2 1... more
CoolClot, a novel hemostatic agent for controlling life-threatening arterial bleeding Large Font Normal Small fonts
SMJ Mortazavi1,2, A Tavasoli3, M Atefi2, N Tanide4, N Radpey1, P Roshan-shomal1, H Moradi2, S Taeb2
1 Radiology Department, School of Allied Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 The Centre for Radiological Research, Shiraz University of Medical Sciences, Shiraz, Iran
3 Shiraz Blood Transfusion Organization, Shiraz, Iran
4 The Centre for Research on Stem Cell, Shiraz University of Medical Sciences, Iran
Corresponding Author: SMJ Mortazavi, Email: mmortazavi@sums.ac.ir
© 2013 World Journal of Emergency Medicine
DOI: 10.5847/ wjem.j.1920–8642.2013.02.007
BACKGROUND: Uncontrolled bleeding is the first leading cause of preventable death in the battlefield and the 2nd cause of mortality in civil accidents. Incompressible hemorrhage control is among the interventions that drastically increase the survival rate in wound individuals. We have previously shown that a certain mixture of bentonite and zeolite minerals can significantly decrease the bleeding in rats.
METHODS: In this study, nine healthy hybrid dogs were selected and after induction of anesthesia with ether, either arterial puncture by a needle or arteriotomy was performed on both groin regions of the dogs. For control arteries (either the right or left femoral artery), only pressure by sterilized gauze was performed, while for the femoral arteries of the opposite side, our invented hemostatic agent, namely CoolClot, was topically used before applying the pressure. In the second stage of the study, to assess the coagulation time, blood samples were collected from 10 volunteer students.
RESULTS: CoolClot significantly decreased the bleeding time in animals whose femoral arteries were cut or punctured. In the human phase of the study, the mean coagulation time in control blood samples was 253.4±44.1 seconds, whereas it was 149.5±50.0, 162.3±74.6 and 143.4±114.6 seconds, respectively in blood samples treated with bentonite, zeolite and CoolClot (P<0.05).
CONCLUSIONS: As controlling bleeding after a life-threatening arterial damage is critical for increasing the chance of survival, the results obtained in this study indicate the significant efficacy of CoolClot in shortening the bleeding time. Our experiments also indicate that CoolClot can significantly reduce the clotting time in human blood samples.
(World J Emerg Med 2013;4(2):123–127)
SMJ Mortazavi1,2, A Tavasoli3, M Atefi2, N Tanide4, N Radpey1, P Roshan-shomal1, H Moradi2, S Taeb2
1 Radiology Department, School of Allied Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 The Centre for Radiological Research, Shiraz University of Medical Sciences, Shiraz, Iran
3 Shiraz Blood Transfusion Organization, Shiraz, Iran
4 The Centre for Research on Stem Cell, Shiraz University of Medical Sciences, Iran
Corresponding Author: SMJ Mortazavi, Email: mmortazavi@sums.ac.ir
© 2013 World Journal of Emergency Medicine
DOI: 10.5847/ wjem.j.1920–8642.2013.02.007
BACKGROUND: Uncontrolled bleeding is the first leading cause of preventable death in the battlefield and the 2nd cause of mortality in civil accidents. Incompressible hemorrhage control is among the interventions that drastically increase the survival rate in wound individuals. We have previously shown that a certain mixture of bentonite and zeolite minerals can significantly decrease the bleeding in rats.
METHODS: In this study, nine healthy hybrid dogs were selected and after induction of anesthesia with ether, either arterial puncture by a needle or arteriotomy was performed on both groin regions of the dogs. For control arteries (either the right or left femoral artery), only pressure by sterilized gauze was performed, while for the femoral arteries of the opposite side, our invented hemostatic agent, namely CoolClot, was topically used before applying the pressure. In the second stage of the study, to assess the coagulation time, blood samples were collected from 10 volunteer students.
RESULTS: CoolClot significantly decreased the bleeding time in animals whose femoral arteries were cut or punctured. In the human phase of the study, the mean coagulation time in control blood samples was 253.4±44.1 seconds, whereas it was 149.5±50.0, 162.3±74.6 and 143.4±114.6 seconds, respectively in blood samples treated with bentonite, zeolite and CoolClot (P<0.05).
CONCLUSIONS: As controlling bleeding after a life-threatening arterial damage is critical for increasing the chance of survival, the results obtained in this study indicate the significant efficacy of CoolClot in shortening the bleeding time. Our experiments also indicate that CoolClot can significantly reduce the clotting time in human blood samples.
(World J Emerg Med 2013;4(2):123–127)
To report the use and describe the interest of hemostatic dressings in a civilian setting, we provided medical prehospital teams with QuikClot Combat Gauze (QCG) and asked physicians to complete a specific questionnaire after each use.... more
To report the use and describe the interest of hemostatic dressings in a civilian setting, we provided medical prehospital teams with QuikClot Combat Gauze (QCG) and asked physicians to complete a specific questionnaire after each use. Thirty uses were prospectively reported. The wounds were mostly caused by cold steel (n=15) and were primarily cervicocephalic (n=16), with 19/30 active arterial bleedings. For 26/30 uses, hemostatic dressing was justified by the inefficiency of other hemostasis techniques. Those 30 applications were associated with 22 complete cessations of bleeding, six decreases of bleeding, and ineffectiveness in two cases. The application of QCG permitted the removal of an effective tourniquet that was applied initially for three patients. No side-effects were reported. The provision of hemostatic dressings in civilian resuscitation ambulances was useful by providing an additional tool to limit bleeding while rapidly transporting the injured patient to a surgical facility.
Les secours médicaux préhospitaliers sont parfois confrontés à des saignements externes difficilement maîtrisables par les moyens habituels (compression, pansements compressifs, garrot…). De nombreux pansements imprégnés de produits... more
Les secours médicaux préhospitaliers sont parfois confrontés à des saignements externes difficilement maîtrisables par les moyens habituels (compression, pansements compressifs, garrot…). De nombreux pansements imprégnés de produits hémostatiques ont été développés depuis une dizaine d’années pour tenter de faire face à ces situations. Leur emploi a principalement été décrit et étudié en milieu militaire pour des blessures de guerre. Nous rapportons le cas d’un ouvrier victime d’un accident de chantier avec délabrement périnéal hémorragique pour qui l’utilisation d’un pansement hémostatique QuikClot ACS+TM (Z-Medica) nous a semblé particulièrement utile en préhospitalier.
First responders are sometimes confronted with external uncontrolled hemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agent were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic périnéal trauma for whom the use of a haemostatic bandage QuikClot ACS+TM (Z-Medica) seemed to us particularly useful in prehospital setting.
First responders are sometimes confronted with external uncontrolled hemorrhage despite compression, bandages, and tourniquets. Several topical haemostatic agent were developed to try to face these situations. Their application was mainly described and studied in military environment. We report the case of a worker victim of an accident of construction site with hemorrhagic périnéal trauma for whom the use of a haemostatic bandage QuikClot ACS+TM (Z-Medica) seemed to us particularly useful in prehospital setting.
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