Hemostatic Research Articles

Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding.

Non-variceal upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality. Traditionally, through-the-scope (TTS) clips, thermal therapy, and injection therapies are used to treat GI bleeding. In this review, we provide an overview of novel endoscopic treatments that can be used to achieve hemostasis. Specifically, we discuss the efficacy and applicability of over-the-scope clips, hemostatic agents, TTS doppler ultrasound, and endoscopic ultrasound, each of which offer an effective method of reducing rates of GI rebleeding.

Physical and mechanical properties of cellulose based hemostatic agents: an in vitro comparison

Physical and mechanical properties of cellulose based hemostatic agents: an in vitro comparison

Blue Laser Triggered Hemostatic Peptide Hydrogel for Gastrointestinal Bleeding Treatment.

In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large-diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self-assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β-sheet nanofiber and solvent-induced self-assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.

Efficacy, Safety, and Pharmacoeconomic Evaluation of Injectable Spearhead Pit Viper Hemagglutinin in Local Hemostatic Treatment of Non-Ruptured Upper Gastrointestinal Bleeding

Objective: To evaluate the efficacy, safety, and drug affordability of injectable spearhead pit viper hemagglutinin (TTP) in the local hemostatic treatment of non-ruptured upper gastrointestinal bleeding, and to provide an evidence-based reference for its rational clinical application. Methods: 80 cases of acute non-variceal upper gastrointestinal bleeding patients admitted to the hospital from October 2022 to April 2023 were screened as research subjects, and divided into a control group and a research group, both including 40 patients. The control group was selected to give hemostatic treatment for endoscopic bleeding foci according to the condition in endoscopic operation by clamping and coagulation, while the research group was selected to provide local hemostatic treatment for non-ruptured bleeding foci in endoscopic operation. The study group was given hemostatic treatment to endoscopic bleeding foci during endoscopic operation according to the condition (endoscopic spraying hemostasis or submucosal injection hemostasis). The study observed and analyzed the effectiveness, adverse reactions, as well as hospital stay, and cost of the patients in the two groups. Results: The total effective rate of hemostasis in the control group was 75.00%, and the total effective rate of hemostasis in the study group was 95.00%, which was significantly better than that in the control group (P < 0.05). The incidence rate of adverse events in patients in the experimental group was 5.00%, while that in the control group was 7.50%, and the difference between the two groups was not statistically significant (P > 0.05). The hospital stay in the patients in the study group was 3.02 ± 1.41 days, and the average hospitalization cost was 5274.89 ± 1691.21 yuan, both of which were significantly lower than 5.93 ± 1.43 days, and 11220.12 ± 3202.14 yuan in the control group, and the difference was statistically significant (P < 0.05). Conclusion: TTP, as a new type of hemostatic agent, can significantly improve the efficacy of upper gastrointestinal bleeding and has good affordability, so it can be considered for promotion and application in the clinic.

Functional and structural neurodegenerative activities of Ankaferd BloodStopper in a mouse sciatic nerve model.

Traumatic and postoperative hemorrhages are life-threatening complications. Ankaferd BloodStopper (ABS) is a potent topical hemostatic agent to stop bleeding. However, ABS is associated with nerve toxicity. The present study aimed to investigate the functional and structural neurodegenerative effects of ABS in a mouse model. A total of 30 male BALB/c mice, aged 6-8 weeks, were randomly divided into control group (no treatment), a sham group (treated with saline) and an experimental group (treated with ABS). In the saline and the ABS groups, the right sciatic nerve was surgically exposed and treated with saline or ABS, respectively. No surgical procedure was performed in the control group. On day 7 post-treatment, functional changes of the sciatic nerve were evaluated by a horizontal ladder rung walking task. Structural changes were assessed with immunohistochemistry. In the horizontal ladder rung walking test, the gait impairment was proportional to the severity of sciatic nerve damage, with the ABS group showing a significantly higher rate of errors than the control and saline groups. Immunohistochemistry demonstrated extensive degeneration and deformation in the axons and myelin sheath of the sciatic nerve in the ABS group. The results provide compelling evidence for the neurotoxicity of ABS.

Injury to the Superior Gluteal Artery During Minimally Invasive Sacroiliac Joint Fusion: A Case Series.

A rarely reported complication with sacroiliac joint fusion (SJF) is an iatrogenic injury to the superior gluteal artery (SGA). This case series includes 3 cases which had a suspected injury to the SGA. Case 1 describes how hemostasis achieved with exploration of the wound followed by embolization by interventional radiology (IR). In Case 2, electrocautery, hemostatic agents, and pressure were used with success. Case 3 highlights the use of IR as the initial method for controlling bleeding. This report describes a rare complication during SJF and provides an algorithm to help guide surgeons in decision making.

Antifibrinolytic and Adjunct Hemostatic Agents: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.

To derive systematic-review informed, modified Delphi consensus regarding antifibrinolytic and adjunct hemostatic agents in neonates and children supported with extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE consensus conference. A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. Use of antifibrinolytics (epsilon-aminocaproic acid [EACA] or tranexamic acid), recombinant factor VII activated (rFVIIa), or topical hemostatic agents (THAs). Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Eleven references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. One weak recommendation and three consensus statements are presented. Evidence supporting recommendations for administration of antifibrinolytics (EACA or tranexamic acid), rFVIIa, and THAs were sparse and inconclusive. Much work remains to determine effective and safe usage strategies.

Dose Comparison of Flowable Gelatin Hemostatic Matrix for Bleeding Loss in Primary Total Knee Arthroplasty.

Introduction Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) affects postoperative outcomes. Although the hemostatic effect of a flowable gelatin hemostatic matrix (FGHM) is known across several surgical fields, its effectiveness on TKA remains controversial. This study aimed to compare the amount of bleeding across three groups treated with different doses of FGHM in TKA. Methods Overall, 122 knee joints of patients who underwent unilateral primary TKA were included and divided into three groups according to FGHM dose: absence of FGHM (control group, N=48), administration of 5 mL of FGHM (5 mL group, N=46), and administration of 8 mL of FGHM (8 mL group, N=38). Total hemoglobin (Hb) loss, drain output, hidden blood loss (HBL), calculated total blood loss (TBL) on the first postoperative day (POD1) and one week postoperatively (POD7), postoperative flexion angle at one week and discharge, and incidence of postoperative deep venous thrombosis (DVT) were assessed. Results At POD1, the mean total Hb losses were 6.3±3.1g (control group), 5.5±3.3g (5 mL group), and 5.3±2.5g (8 mL group), with no significant differences. At POD7, the mean Hb losses were 9.1±4.6g (control), 8.7±3.6g (5 mL), and 8.3±4.0g (8 mL), also with no significant differences. Mean drain outputs and HBLs showed no significant differences among groups. While there was a decreasing trend in TBL with higher FGHM doses, it was not statistically significant at either POD1 or POD7. There were no statistically significant differences in the mean postoperative flexion angle at POD7 or discharge among the groups (99.7±12.6°, 95.7±12.5°, 98.3±13.8° at POD7; 115.9±9.7°, 113.8±9.6°, 116.6±9.2° at discharge). Of these, only one patient in the 8 mL group developed proximal DVT. Conclusion Despite a trend towards decreased bleeding with FGHM, no significant differences were found among the three groups. However, the clinical utility of this hemostatic agent for reducing blood loss after primary TKA remains still unclear.

Giant gastric polyp complicated by bleeding and chronic duodenal obstruction (clinical case)

The article describes a case of treatment of a giant gastric polyp complicated by bleeding and chronic duodenal obstruction by a new method of endoscopic surgical hemostasis by endoscopic polypectomy using a polymer alginate hemostatic sorbent. The proposed endoscopic polypectomy method using a local hemostatic agent made it possible to prevent hemorrhagic complications, create conditions for full-fledged reparative regeneration, which made it possible to exclude recurrence of the polyp at the site of its removal in the long term.

Haemostatic biomaterial based on expired platelets for medical applications

Blood loss has been a concern especially in surgery and bleeding control and a number of haemostatic agents and tissue sealants have been developed and applied in various surgical disciplines. The first steps to stop bleeding due to a vascular lesion, limit blood loss and allow healing are ensured by platelets that play an essential role in forming the primary haemostatic plug. After this, the clot is consolidated by the formation of a fibrin network organized around platelet aggregates. In this study we tested for the treatment of external haemorrhagic lesions a new biomaterial based on expired platelets from blood banks immobilized on a collagen support. These platelets are no longer used for transfusions, are safe (tested for viral and bacterial contamination) and still have local haemostatic activity. Collagen is non-toxic, non-antigenic and promotes cell adhesion. Platelets bind to the collagen support and subsequently form clots through the intrinsic coagulation pathway.

Dencichine/palygorskite nanocomposite incorporated chitosan/polyvinylpyrrolidone film for accelerating wound hemostasis

The development of efficient, safe, environmentally friendly, and user-friendly hemostatic dressings remains a great challenge for researchers. A variety of clay minerals and plant extracts have garnered considerable attention due to their outstanding hemostatic efficacy and favorable biosafety. In this study, a facile solution casting strategy was employed to prepare nanocomposite films by incorporating natural nanorod-like palygorskite (Pal) and herb-derived hemostat dencichine (DC) based on chitosan and polyvinylpyrrolidone. The dynamic blood clotting index demonstrated that the nanocomposite film with a DC addition of 1.0 wt% exhibited significantly superior hemostatic properties compared to both pure DC powder or commercial hemostatic agent Yunnan Baiyao. This improvement was primarily attributed to proper blood affinity, increased porosity, enhanced adhesion of platelets and erythrocytes, as well as the accelerated activation of coagulation factors and platelets. Under the synergistic effect of Pal and DC, the nanocomposite film displayed suitable tensile strength (20.58 MPa) and elongation at break (47.29 %), which may be due to the strong intermolecular hydrogen bonding and electrostatic interaction between Pal/DC and macropolymers. Notably, the nanocomposite film exhibited remarkable antibacterial effectiveness and desirable cytocompatibility, as well as the capability of promoting wound healing in vitro. Taken together, the nanocomposite film synergized with Pal and DC is expected to be an efficacious and suitable wound dressing.

Rational Design and Testing of Antibacterial Aloe Vera Hemostatic Hydrogel.

Bleeding resulting from surgical procedures or trauma, including gunshot wounds, represents a life-threatening health issue. Therefore, the development of safe, effective, and convenient hemostatic agents is critical in securing the "golden time" to save patients' lives. Plant-derived compounds and plant extracts have been regarded as promising sources of hemostatic agents in previous studies, regulating hemostatic function with low toxicity and minimal side effects within the human body. Aloe vera-based hydrogels, which are characterized by flexible strength and high functionality, have emerged as a promising platform for wound applications due to their unique biocompatibility features. This study provides a comprehensive exploration of the utilization of thickening agents and natural agents such as xanthan gum, carrageenan, Carbomer, and alginate in applying aloe vera-based hydrogels as a hemostatic. Furthermore, it also tests the use of aloe vera-based hydrogels for therapeutic delivery at wound sites through the incorporation of various antimicrobial agents to extend the utility of the hydrogels beyond hemostasis. Our novel applied research utilizes aloe vera-based hydrogel as an antimicrobial hemostatic agent, providing valuable insights for a wide range of applications and highlighting its potential to enhance hemorrhage control in various emergency scenarios.

Platelet-Rich Plasma-Embedded Porous Polycaprolactone Film with a Large Surface Area for Effective Hemostasis.

Uncontrollable and widespread bleeding caused by surgery or sudden accidents can lead to death if not treated with appropriate hemostasis. To prevent excessive life-threatening bleeding, various hemostatic agents based on polymeric biomaterials with various additives for accelerated blood coagulation have been adopted in clinical fields. In particular, platelet-rich plasma (PRP), which contains many blood coagulation factors that can accelerate blood clot formation, is considered as one of the most effective hemostatic additives. We investigated a PRP-embedded porous film using discarded (expired) PRP and a film with a leaf-stacked structure (FLSS), as a hemostatic agent to induce rapid hemostasis. The film, which contained an LSS on one side (PCL-FLSS), was fabricated by a simple heating-cooling technique using tetraglycol and polycaprolactone (PCL) film. Activated PRP was obtained by the thawing of frozen PRP at the end of its expiration date (the platelet cell membrane is disrupted during the freezing and thawing of PRP, thus releasing various coagulation factors) and embedded in the PCL-FLSS (PRP-FLSS). From in vitro and in vivo experiments using a rat hepatic bleeding model, it was recognized that PRP-FLSS is not only biocompatible but also significantly accelerates blood clotting and thus prevents rapid bleeding, probably due to a synergistic effect of the sufficient supply of various blood coagulants from activated PRP embedded in the LSS layer and the large surface area of the LSS itself. The study suggests that PRP-FLSS, a combination of a porous polymer matrix with a unique morphology and discarded biofunctional resources, can be an advanced hemostatic agent as well as an upcycling platform to avoid the waste of biofunctional resources.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial.

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4weeks) between groups. CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

An Alternative Option to Compression Hemostasis in Case of Esophageal Vein Bleeding in Patients with Portal Hypertension

Introduction. Compression hemostasis is widely used to arrest bleeding from veins of the esophagus in portal hypertension. Since it has a number of severe drawbacks, research is relevant to develop new approaches to solve this problem.The aim of the study was to provide evidence and develop a technique to arrest bleeding from varicose veins of the esophagus, which can become an alternative to compression hemostasis.Materials and methods. The key technology in the study was chemical-mechanical hemostasis – the combined esophageal vein compression and Hemoblock application. At the first stage, this technique was tested on laboratory animals - domestic pigs, since a model of the esophageal vein bleeding was formed in their bodies. At the clinical stage, chemical-mechanical hemostasis was performed in 15 patients with the recurrent esophageal vein bleeding; they made up the experimental group. The control group consisted of 15 patients subjected to compression hemostasis. The hemostatic effectiveness of the techniques and their assessment by the patients themselves were compared in the study.Results. In the experimental group, bleeding was arrested in 46.7% of cases by installing a probe for chemical-mechanical hemostasis with a 5-minute exposure. In the control group, bleeding was arrested in 66.7% of cases by installing an obturator probe with a 10- to 24-hour exposure. As patients’ survey reported, in the control group, patients experienced pain during the insertion of the obturator probe in 86.7% of cases, and 20% of patients experienced pain during the entire time the obturator probe was in the esophagus; 93.3% of patients expected an early termination of the procedure, 13.3% claimed that they would never agree to the procedure again. As patients’ survey reported, in the experimental group, 6.7% of patients experienced pain when inserting the probe for chemical-mechanical hemostasis and during the time, it remained in the body. 46.7% of patients wanted the procedure to be terminated as soon as possible. There were no patients who refused to repeat a procedure of chemical-mechanical hemostasis if required.Conclusions. The study demonstrated that a modified conventional obturator probe, which allowed combining compression of the esophageal veins with the hemostatic drug effect, resulted in a significantly increased hemostatic effect in case of the esophageal vein bleeding. During the study, this technique prevented 46.7% of patients from the need to use an obturator probe. Since the obturator probe, when applied, causes a large number of troublesome and painful sensations (a fact reported by 93.3% of patients), even its partial elimination can be considered as an option improving the quality of the treatment.

Mesh-shaped absorbable hemostatic hydrogel patch fabricated with marine organism-derived protein biomaterials with contact-activated blood coagulation for application in visceral surgery

The utilization of efficacious hemostatic agents in surgical procedures has the potential to enhance operational efficacy, expedite patient recovery, and diminish the need for blood transfusions. However, in cases of excessive bleeding, few commercial hemostatic agents can maintain contact with the bleeding site and perform hemostatic functions effectively. In the present work, we propose a mesh-shaped absorbable lyophilized hemostatic hydrogel patch with excellent biodegradability, wet tissue adhesion ability, strong structural properties, and good blood coagulation activity by integrating the beneficial properties of two marine organism-derived bioengineered protein biomaterials, sea anemone silk-like protein (aneroin) and mussel adhesive protein (MAP). The hemostatic efficacy of the developed hydrogel patch was thoroughly evaluated using in vitro and in vivo experiments. The mesh-shaped hemostatic hydrogel patch exhibited the ability to absorb plasma upon contact with blood, adhere to surfaces, and facilitate aggregation of blood components, hence enhancing the process of blood coagulation. Using animal liver damage models, we confirmed that the hemostatic hydrogel patch could significantly enhance hemostatic capabilities by reducing clotting time and blood loss while exhibiting minimal inflammation and toxicity when remaining within the body. Thus, our proposed absorbable hemostatic hydrogel patch demonstrated great potential for use as a novel adhesive hemostatic agent for application in visceral surgery.

Strategies for Performing Factor Assays in the Presence of Emicizumab or Other Novel/Emerging Hemostatic Agents.

For several decades, therapeutic options for inherited deficiencies of factor VIII or IX (hemophilia A or B, respectively) have largely been the replacement of the missing clotting factor with plasma-derived or recombinant products. Hemostasis laboratories use standard activated partial thromboplastin time (aPTT)-based clotting or chromogenic assays to monitor plasma factor levels to guide therapy. The emergence in the past 10 years of extended half-life replacement products and other novel therapies for hemophilia has led to a reappraisal of assay suitability, with studies of product measurement showing some existing assay types or reagents to be unsuitable for some products. The hemostasis laboratory must adapt to the changing landscape by adding new assays or modifying existing assays to ensure accurate results for product measurement. These strategies include switching from a chromogenic assay to a clotting assay, or vice versa, changing an aPTT reagent brand, or introducing product specific calibrators. This article evaluates the effects of some of the newer treatment options on the laboratory testing of factor levels and related assays.

Usefulness and Safety of Gelatin-Thrombin Matrix Sealants in Minimally Invasive Microscopic Discectomy.

Objective This study aimed to evaluate the usefulness and safety of gelatin-thrombin matrix sealants (GTMSs) in minimally invasive microscopic discectomy, a surgical procedure commonly used to treat lumbar disc herniation. Materials and Methods Out of 484 patients who underwent minimally invasive microscopic discectomy between April 2018 and December 2022, 35 patients with a history of surgery at the same level were excluded, resulting in a total of 449 patients included in the study. Among them, 316 patients were treated using GTMS, whereas 133 were treated using collagen-based absorbable local hemostatic agents. Patient characteristics, surgical duration, intraoperative blood loss, postoperative drainage volume, intraoperative dural injury, and incidence of postoperative epidural hematoma were analyzed and compared between the two groups. Results No significant differences in patient demographics were observed between the two groups, except for activated partial thromboplastin time and prothrombin time. Although there were no significant differences in the mean surgical time and intraoperative blood loss between the two groups, they tended to be shorter and less in the GTMS group (56.3 ± 20.2 vs. 58.2 ± 20.4 minutes [ p = 0.36] and 10.0 ± 15.4 vs. 11.8 ± 8.3 g [ p = 0.20]). The volume of postoperative drainage was significantly lower in the GTMS group than that in the comparison group (35.3 ± 21.8 vs. 49.5 ± 34.1 g [ p < 0.01]). There was a trend indicating a difference in the number of intraoperative dural injuries and the need for reoperation due to postoperative epidural hematoma (2 vs. 3 ± 20.4 minutes [ p = 0.21] and 1 vs. 2 [ p = 0.16]). Conclusion The use of a GTMS in minimally invasive microscopic discectomy appears to be beneficial in reducing postoperative drainage volume. It has also been shown that it may improve clinical outcomes such as intraoperative dural injury and postoperative epidural hematoma. Furthermore, further consideration of the medical economic impact is required.

Efficiency Analysis of Hemostatic Agents in Drainless Neck Surgery: Cellulose-Based Versus Liquid Fibrin Sealants.

Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries.This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries. A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both. A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001). Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.

The use of Arista AH as a local haemostatic agent in distal splenopancreatectomy: report of two cases.

Bleeding is still one of the most feared intraoperative and postoperative complications that can lead to an increase in morbidity, mortality, length of hospital stay and costs. Nowadays, in addition to accurate surgical techniques, several local haemostatic agents are available and can be used in case of oozing bleeding. Herein, we report our experience with a ready-to-use polysaccharide powder in two patients undergoing distal splenopancreatectomy. Bleeding control was achieved in both cases. No patient showed postoperative bleeding, and no other complications were reported.