Effects Of Hemostatic Agents Research Articles

Management of DOAC-related bleeding in cancer patients: a single center-case series.

Venous thromboembolism (VTE) and stroke carry significant mortality and morbidity in cancer patients. Direct oral anticoagulants (DOACs) have been demonstrated to be effective for the treatment of VTE and prevention of stroke in atrial fibrillation (AF). Bleeding rates are variable and are based on the cancer type and the patient's specific risk factors. There are approved specific antidotes for DOAC-associated bleeding. Other strategies are available for bleeding reversal, including the use of prothrombin complex concentrate (PCC). No randomized studies have compared head-to-head the efficacy and safety of reversal agents. We aim to examine the safety and effectiveness of hemostatic agents in cancer patients with DOAC-related major bleeding. A retrospective chart review study of patients at MD Anderson Cancer Center with DOAC-related major bleeding between 2014 and 2019. Bleeding severity and clinical hemostasis were described based on ISTH guidelines and the Sarode criteria, respectively. The rates of thrombotic complications and mortality at 30-day from the index bleeding event were described. We identified 23 patients with DOAC-related major bleeding; 14 patients received PCC and 9 patients received andexanet alfa. The most common sites of bleeding were the gastrointestinal tract and intracranial. Effective hemostasis and 30-day mortality were similar to reported results from other reports of outcomes of reversal agents for DOAC related-bleeding in non-cancer patients. One patient in each treatment group experienced a thrombotic event. Further larger scale studies are needed to confirm our findings in cancer patients.

Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide

ObjectiveThis study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery. MethodsThe authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery. ResultsThis guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted. ConclusionPain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.

A study on the effect of hemostatic agent and Kampo medicine (goreisan) for the clinical course of chronic subdural hematoma

A study on the effect of hemostatic agent and Kampo medicine (goreisan) for the clinical course of chronic subdural hematoma

A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

Effectiveness of hemostatic agents in thyroid surgery for the prevention of postoperative bleeding

Postoperative bleeding remains one of the most frequent, but rarely life-threatening complications in thyroid surgery. Although arterial bleeding is the main cause of postoperative hemorrhage, most often no actively bleeding vessel can be found during revision. Therefore, the coagulation technique for larger vessels may play a minor role, and hemostatic agents could be of higher importance. In this descriptive, retrospective study, data of 279 patients with thyroid surgery (total of 414 thyroid lobectomies) were collected. We reviewed the electronic medical record by analyzing the histological, operative, laboratory and discharge reports in regards to postoperative bleeding. Of the 414 operated thyroid lobes, 2.4% (n = 10) bled. 1.4% (n = 6) needed reoperation while the other 1.0% (n = 4) could be treated conservatively. Hemostatic patches were applied 286 (69.1%) times. Of the 128 (30.9%) patch-free operated sides, 4.7% (n = 6) suffered postoperative bleeding. Tachosil® alone was used 211 (51.0%) times and bleeding occurred in 1.4% (n = 3). Without statistical significance (p = 0.08) the use of Tachosil® seems to help preventing postoperative bleeding. The combination with other patches doesn’t appear to be more efficient.

Effects of haemostatic agents on bond strength - An In Vitro study.

To evaluate and compare the effect of contamination with haemostatic agents like Tranexamic Acid (TA) and Ethamsylate, on the shear bond strength. There are about 100 extracted human premolars randomly segregated into four groups each consisting of 25 samples. Group I was bonded with Transbond, Group II was bonded with Transbond after blood contamination, while groups III and IV were bonded with Transbond after contamination with Tranexamic acid and the shear bond strength was measured. The data were compared by One- way ANOVA and Tukey (HSD) tests. Group I had the highest shear bond strength (SBS) while Group II, where the teeth were contaminated with blood showed the least SBS values ANOVA indicated significant differences between the four groups (P < .05). Tukey HSD revealed that contamination with TA (Group III) had a statistically higher SBS that contamination with Ethamsylate (Group IV) (P < .05). Since tranexamic acid and ethamsylate reduces the bleeding when used during surgery, these haemostatic agents may be considered in bonding situations where blood contamination is anticipated.

The Effect of Hemostatic Agents on the Retention Strength of Zirconia Crowns Luted to Dentin Abutments.

The purpose of this study was to investigate whether hemostatic agents (HA) show an effect on the retention strength (RS) of zirconia crowns luted to dentin abutments after cleaning with an air/water spray. Human molars (N = 60/n = 12) were prepared and zirconia crowns were milled. Prior to luting (Scotchbond Universal/RelyX Ultimate), molars were pretreated using HA: i. 25% AlCl3 (VSC), ii. 20% Fe2(SO4)3 (VS), iii. 15.5% Fe2(SO4)3 (AS), iv. 12.7% iron ion solution (ASX) and v. no pretreatment (control). Mastication simulation and pull-out tests were performed. Failure types were defined: cohesive 1—tooth root; cohesive 2—tooth crown; adhesive 1—cement on tooth; adhesive 2—cement on tooth and crown; mixed—adhesive/cohesive. Data were analyzed using 1-way ANOVA, post-hoc Scheffé, Pearson’s chi-square-test and Ciba–Geigy table (p = 0.05). No RS differences between the tested groups were observed (p = 0.200). ASX fractured more cohesive 2 than the control group. VSC showed more cohesive 2 than adhesive 1 fractures. VS showed more adhesive 2 than mixed fractures. AS showed more cohesive 2 than adhesive 1 and more adhesive 2 than mixed fractures. ASX showed predominantly cohesive 2 fractures. RS was not affected when HA were cleaned off by 30 s of air/water spray prior to luting. HA still seem to weaken the dentin abutment, making it prone to cohesive fractures.

Effect of hemostatic agent on microshear bond strength of total-etch and self-etch adhesive systems

Application of hemostatic agents can negatively affect the bond strength of adhesive systems to dental substrate. This study aimed to assess the effect of ferric sulfate on microshear bond strength of four total- and self-etch adhesives to dentin after water storage. In this in vitro study, 192 dentin slices with 2 mm thickness were made of 64 extracted sound human third molars. The samples were divided into 8 groups (n = 24) as follows: G1: Scotchbond Multi-Purpose, G2: hemostatic agent + Scotchbond, G3: Adper Single Bond, G4: hemostatic agent + Adper, G5: Clearfil SE Bond, G6: hemostatic agent + Clearfil, G7: Single Bond Universal, and G8: hemostatic agent + Single Bond Universal. Composite cylinders with 0.7 mm diameter and 1 mm height were bonded to the surfaces. Each group was then divided into two subgroups (n = 12) for water storage for 24 h and 3 months. The microshear bond strength was then measured. Data were analyzed using the Shapiro-Wilk test, three-way ANOVA, one-way ANOVA, and Tukey's test (P < 0.05). Application of ferric sulfate decreased the bond strength of all bonding agents after both 24 h and 3 months of storage; but, this reduction was not statistically significant (P > 0.05). Single Bond Universal at 24 h showed the highest and Adper Single Bond at 3 months showed the lowest bond strength (P < 0.001). Dentin contamination with hemostatic agents negatively affects the bond strength of total- and self-etch adhesives.

A novel hemostatic scaffold material and the importance of scaffold formation on ending hemorrhage: An experimental rat study.

Different pharmacological agents are developed to control bleeding. However, it is critical for these agents to induce thrombin formation and have an effect on vasoconstriction, coagulation, and scaffold. In this study, we aimed to demonstrate the agents' ability to stop bleeding properties on minor and major open bleedings after skin clefts, extracorporal injuries, traumatic cuts, spontaneous or surgical intervention besides scaffold properties. For this purpose, a new and authentic hemostatic agent, processed diatomite (PD) and the most preferred chitosan in the medical area were used to test blood stopping and scaffold effects in a rat femoral bleeding model. The samples were examined by scanning electron microscopy (SEM), and the results on blood stopping were shared. The current experimental study was conducted on rats. The effects of hemostatic agents on our femoral bleeding model were determined. In this study, 22 male Wistar albino rats weighing 158-215 g, were used. The rats were assigned randomly to three groups: control group (n=6), chitosan group (n=8), and PD group (n=8). Bleeding time, scaffold formation, weight differences, histopathological effect and scanning electron microscope (SEM) analyses were performed. In our experimental model, weight loss was 5.0±1.3 g for the control group, 2.9±1.1 g for the chitosan group, and 2.7±1.0 g for the PD group, respectively. When weighed before and after the experiment, there was a significant change in weights of rats in chitosan, and PD groups regarding scaffold formation: it was complete for six rats (75%) and weak for two (25%) rats in chitosan group; however, it was complete for seven rats (87.5%) and weak for one (12.5%) rat in the PD group. Scaffold formation was significant for the chitosan and PD groups versus the control group (p=0.002). In our study, the scaffold formed by PD exerts appropriate porousness and contributes to fibrin formation and prevent re-bleeding. PD had a strong and significant scaffold effect. The effectiveness of PD to stop bleeding was equal to chitosan. Besides being natural, hemostatic agents should not induce cellular damage. We histopathologically demonstrated that PD was harmless for the natural structure of cells and vessels in the femoral site.

Effect of hemostatic agent on bonding strength of deciduous tooth dentin

To investigate the effect of hemostatic agent on bonding strength of deciduous tooth dentin. Forty deciduous molars were used to make dentin grinding model and randomly divided into observation group and control group, 20 teeth in each group. Teeth in the observation group were covered with hemostatic agent for 30s, and then washed, followed by processing; while teeth in the control group were subjected to bonding directly. Micro tensile bond strength and micro leakage were measured and compared in the two groups. SPSS19.0 software package was used to analyze the data. Micro tensile bond strength of the observation group was (12.84±2.10) MPa, significantly lower than that of the control group (P<0.05); most resin protrusion in the observation group was > 35 μm and long and dense, extending into the open dentinal tubules; while resin protrusion in the control group was about 7 to 35 μm, with obvious collateral communication. There was no significant difference in the degree of micro leakage between the two groups (P>0.05). Hemostatic agent has certain impact on the dentin bonding strength of deciduous tooth, special attention should be paid during clinical application.

Effect of hemostatic agent on marginal gaps of class V giomer restorations.

BackgroundContamination of dentin with hemostatic agents might exert a deleterious effect on adhesive procedures on dentin. The present study was undertaken to investigate the effect of aluminum chloride hemostatic agent on marginal gaps in Cl V giomer restorations.Material and MethodsFifty sound bovine permanent incisors were selected for the purpose of this in vitro study and Cl V cavities were prepared on their buccal surfaces; the gingival margins of the cavities were placed in dentin. The tooth samples were randomly assigned to two groups (n=25). The samples in groups 1 and 2 underwent a restorative procedure without and with the application of aluminum chloride hemostatic agent in the cavity, respectively, before application of the adhesive. BeautiBond one-step self-etch adhesive and Beautifil II giomer restorative material were used for the restoration of the cavities in both groups. The samples were thermocycled and sectioned, followed by measuring the gap sizes at gingival margins in µm under a stereomicroscope. The marginal gaps were compared with Mann-Whitney U test. Statistical significance was set at P<0.05. ResultsThe results showed significant differences in the mean marginal gaps between the two groups under study (P<0.001); the mean marginal gaps were higher in group 2 (with hemostatic agent) compared to those in group 1 (without hemostatic agent) (P<0.0005).ConclusionsContamination with aluminum chloride hemostatic agent in giomer restorations gave rise to higher gingival margin gaps. Key words:Dental adhesives, giomer restorative material, hemostatic agent, marginal adaptation.

Efficacy of Hemostatic Agents in Humans With Rotational Thromboelastometry: An in-vitro Study.

Hemorrhage is the leading cause of preventable death in military conflicts. Different types of hemostatic dressings have been compared in animal studies for their ability to control bleeding. However, the effects of hemostatic agents in animals may be different from those in humans. The aim of this study was to assess the efficacy of hemostatic dressings in human blood. Clotting time, clot formation time, α-angle, maximum clot firmness, and lysis index of human blood incubated with QuikClot Gauze, Celox Gauze, QuikClot ACS+, and standard gauze, were compared using rotational thromboelastometry (ROTEM). Nonactivated, intrinsically activated, extrinsically activated, and fibrin-based ROTEM were used to elucidate different mechanisms of action of those dressings. QuikClot Gauze was the most efficacious hemostatic dressing, followed by Celox Gauze and standard gauze. QuikClot ACS+ was clearly outperformed. Modern hemostatic dressings such as QuikClot Gauze and Celox Gauze should be preferred to previous generations of hemostatic dressings, such as QuikClot ACS+. In vitro studies like ROTEM can provide valuable information about the mechanisms of action of hemostatic dressings. A combination of different mechanisms of action may increase the efficacy of hemostatic dressings.

Comparison of the acute effects of hemostatic agents on neural tissues in spine surgery: Histologic analysis in rat models

Objective: The most frightening and likely complication of chemical hemostatic agents is neurologic deficit. The histological basis of this potential complication is still unknown. The aim of this study is to observe the acute histologic effects of routinely used hemostatic agents on neural tissues in a rat model. Methods: Eighteen Winstar Albino rats were operated and same-level laminectomies were performed. The rats were divided into three groups. In group 1 (control group), surgical layers were sutured in routine manner after laminectomy. In group 2 (gelatin sponge group), dura mater was covered with gelatin sponge after laminectomy, while oxidized cellulose was used for coverage in group 3 (oxidized cellulose group). Neurologic evaluations were made for all test subjects. Fortyeight hours after the operation, rats were sacrificed and lumber spines were excised with all surrounding tissues for evaluation by light microscopy of the acute effects of agents on neural tissues. Neurologic scores and histologic findings were compared with double-blind evaluation. Results: There were no statistically significant differences between the three groups in the histologic findings and clinical evaluations. However, the inflammatory reaction was more severe in the oxidized cellulose group. Conclusion: Both gelatin sponge and oxidized cellulose did not increase the cellular necrosis of neural tissues. However, oxidized cellulose may lead to an increased local inflammatory reaction.

Effects of hemostatic agents on shear bond strength of orthodontic brackets.

The aim of this study was to determine the effects of blood contamination and hemostatic agents on shear bond strength (SBS) of brackets and bond failure. The study material consisted of 57 freshly extracted human premolar and randomly divided into four groups: Group I, control group (n0 = 14); Group II, contamination with blood (n = 13); Group III, contamination with epinephrine ( n = 14); and Group IV, contamination with Ankaferd blood stopper (ABS) ( n = 16). After the bracket bonding procedure, all bonded teeth thermal cycled in deionized water at 5 ± 2°C to 55 ± 2°C for 500 cycles. SBS was applied using a universal test machine. According to Kruskal-Wallis test significant differences were found among the groups P < 0.05. Furthermore, significant differences were recorded between groups with Mann-Whitney U statistical test with Bonferroni correction (P = 0.0083). Examples contaminated with blood showed a statistically significant lower in vitro SBS than those contaminated with epinephrine, ABS, and control groups. In impacted tooth surgical operations, blood contamination poses a substantial risk of bond failure in bonding attachments applications to the impacted teeth. Epinephrine and ABS may be used on surgical exposed impacted teeth operation for the prevention of blood contamination.

The effect of hemostatic agents and tissue adhesive on injured peripheral nerve healing in rats - Part I. Electrophysiological study.

In the practice of maxillofacial surgery, bleeding and nerve injury have common problems. In the control of bleeding, hemostatic agents and tissue adhesives have been frequently used. The effect of these hemostatic agents and tissue adhesives on the injured neural tissues has not been known. In this study, we aimed to investigate the effects of hemostatic agents and tissue adhesive on injured nerve tissues. Forty-two rats randomly divided into seven groups: Control, Oxidized Regenerated Cellulose (ORC), Gelatine Sponge (GS), Bovine Collagen (BC), Ankaferd BloodStopper (ABS), Glutaraldehyde Surgical Adhesive (BioGlue®) and N-butil-2 cyanoacrylate (Glubran®2). The left sciatic nerves were crushed and surrounded by hemostatic agents and tissue adhesives. At the end of 12 weeks, the surgical site was reopened and electrophysiological recordings were performed. In the ORC, GS, and BC groups, the compound action potential (CAP) values were lower compared to the control group (p < 0.05). Although the values of CAP in the ABS group were higher than in the control group while CAP values in the BioGlue and Glubran®2 groups were lower than the control group, there was no statistical significance between the experimental and control groups (p > 0.05). In the ORC, BC, GS, and Glubran®2 groups, the nerve conduction velocities (NCV) values were lower than in the control group (p < 0.05). In the ABS and BioGlue groups, NCV values were lower compared to the control group but no significant differences were found (p > 0.05). The present study provides evidence that ABS is the most suitable hemostatic agent due to its favorable effect on the healing of injured neural tissues. BioGlue is also a suitable surgical agent with no adverse effects.

Effects of hemostatic agents on fibroblast cells.

Hemostatic agents may be used topically to control hemorrhage, especially in patients with bleeding disorders. The agent used may have a negative effect on the tissue prolonging the healing time. The aim of this study was to compare the effects of 3 different hemostatic agents on fibroblast cells on a rat primary fibroblast cell culture model. Ankaferd Blood Stopper (ABD) (Ankaferd Pharmaceuticals Cosmetics Production and Marketing Co.), fibrin glue, and tranexamic acid were the agents to be evaluated for their effects on cell proliferation, cell numbers, cell viability, and cell morphology. Also lactate dehydrogenase, basic fibroblast growth factor, and vascular endothelial growth factor C levels were measured. It was found that all of the agents used in the study have negative effects on fibroblasts, with ABD having the lowest values of cell proliferation, cell number, and cell viability. The results of this study indicate that ABD, fibrin glue, and tranexamic acid may negatively affect tissue healing.

Effect of hemostatic agents on properties of gelatin–alginate soft tissue adhesives

Lacerations and traumatic wounds are considered to be among the most prevalent scenarios encountered in hospitals and emergency rooms. Reattachment of the lacerated soft tissue edges is traditionally performed using sutures. Use of tissue adhesives, i.e. substances that have the ability to firmly attach lacerated tissues back together, has raised interest as an alternative, due to several advantages. Novel tissue adhesives based on the natural polymers gelatin and alginate, and cross-linked by carbodiimide (EDC), were recently developed by our research group. In the current research, two types of hemostatic agents, tranexamic acid and kaolin, were loaded into our gelatin–alginate bioadhesive, in order to improve the adhesion abilities in the hemorrhagic environment of the wound. Their effects on the ex vivo adherence properties, physical properties, and biocompatibility were investigated. Incorporation of kaolin significantly improved the ex vivo bonding strength of the gelatin–alginate–EDC bioadhesives through a combination of three physical mechanisms and decreased the swelling ratio without affecting weight loss. In contradiction, incorporation of tranexamic acid into the bioadhesive formulation resulted in a lower ex vivo bonding strength and a higher swelling ratio and weight loss, probably due to reduced efficiency of the cross-linking reaction between the molecules of the natural polymers and the cross-linking agent EDC. The hemostatic agent-loaded bioadhesives showed good biocompatibility when tested in vitro on fibroblast cells. This research clearly shows that the incorporation of kaolin in our gelatin–alginate tissue adhesives may be a very promising novel approach for improving the bonding strength and physical properties of the tissue adhesives for use in hemorrhagic environments.

Effects of fibrin sealer and resorbable gelatin on the repair of osseous defects in rat tibia

Gelfoam - a biologically resorbable gelatin sponge - has the function of restricting hemorrhage, providing platelet rupture, and supporting fibrin threads. Beriplast - a fibrinogen-thrombin compound - is used to adhere tissues, to consolidate sutures and in hemostasis. The objective of this study was to perform a histological analysis of the effects of haemostatic agents on osseous repair. These materials were inserted into surgical sites in young rat right and left tibiae. After the observation periods of 7, 14, 30 and 45 days, according to the bioethic protocol, the animals were killed, the tibiae were removed and fixed in 10% formalin and decalcified in equal parts of formic acid and sodium citrate solutions. After routine processing, the specimens were embedded in paraffin for microtomy. Analysis of the results demonstrated that the haemostatic agents are effective in controlling hemorrhage; they stimulate osteogenesis, featuring a pattern of osseous tissue formation similar to the control pattern, although the amount of osseous trabeculae was superior, especially in the Gelfoam group in the periods of 7 and 14 days; 30 days after surgery, the delay in tissue healing in the control group in relation to the experimental groups started to decrease, and the control and experimental groups exhibited similar tissue repair after 45 days, when all the groups exhibited secondary osseous tissue.

The effects of haemostatic agents on peripheral nerve function: An experimental study

The effects of haemostatic agents on peripheral nerve function: An experimental study

Smear layer instability caused by hemostatic agents

The effect of hemostatic agents, other than a 15.5% Fe 2(SO 4) 3 solution, on prepared tooth structure is unknown. The purpose of this study was to (1) compare the effect of six commonly used hemostatic solutions and two nondental astringents on the dentinal smear layer and (2) determine whether different responses caused by product and/or time could be established. Standardized dentinal smear layers were exposed to eight astringent solutions for 30, 120, and 300 seconds (n = 6). A total of 144 SEM photographs at ×2400 magnification were ranked according to predetermined criteria for five categories of smear layer removal and etching of underlying tooth structure. There were significant differences ( p < 0.001) caused by the solution, exposure time, and their interaction. Greatest smear layer removal was observed with 21.3% AlCl 3-6 hydrate, 8% racemic epinephrine HCl, and 15.5% Fe 2(SO 4) 3 solutions at longer exposures. These caused significantly more removal than did almost pH neutral tetrahydrozoline or oxymetazoline ( p < 0.05).