Use Of Hemostatic Agents Research Articles

Practical guidance on the use of uterine contraction and haemostatic agents

Practical instructions regarding the use of agents that reduce the uterus and hemostatic are given by Strata (Zntrb. F. G., 1924, No. 1-2) on the basis of his long-term observations.

Is the Use of Sealing and Hemostatic Agents Justified in Hepatic Resections? Review and Meta-analysis

The aim of this study was to produce a meta-analysis including only prospective and randomized studies to know real effect using hemostatic sealants on the resection edge after elective hepatic resection, especially regarding biliary fistula and hematoma.

Method for Flushing Surgical Drains Using a Butterfly Needle.

Summary:Surgical drains placed during breast surgery can become blocked by clots or other debris, which may lead to infection of the prosthetic and seroma or hematoma formation from improper drainage. Current methods involve stripping the drain, which does not clear the pores inside the cavity, or flushing the drain at the opposite end using a syringe with the debris going into the cavity being drained. The authors propose an easily available flushing option using a butterfly needle inserted at an angle that provides a sterile and efficient method for flushing the drain near the body cavity and clearing blockages. This creates a self-sealing valve that can be reinforced with Tegaderm and allows for the use of antibiotics or hemostatic agents through it. The primary author has performed this technique in-office in multiple patients undergoing breast augmentation, mastopexy/mammaplasty, breast reconstruction after mastectomy, and breast revision surgeries requiring implants or expanders with satisfactory results and no complications. This method is limited in that it must be performed by a health care professional, but it is easy to perform.

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases.

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

Оценка спаечного процесса после травмы печени в хроническом опыте

Background. The issue of studying the reaction of a macroorganism to use of various local hemostatic agents is relevant. In particular, an important factor for use of a certain hemostatic agent in practical medicine is the low probability of formation of adhesions in the postoperative period after its implantation. Aim. Was to investigate the peculiarities of the course of adhesion process in the abdomen of laboratory animals after liver injury and stoppage of bleeding by local spongy hemostatic agents in an experiment. Materials and Methods. As materials, various samples of spongy hemostatic agents were used: Tachocomb®, Na-CMC + tranexamic acid, Na-CMC. The study was performed on male rabbits of the «Soviet chinchilla» breed (10 in each experimental group) in the operating unit of the laboratory of experimental surgery and oncology of the Research Institute of Experimental Medicine of KSMU. Surgical intervention was performed using a video-surgical complex, a liver wound was formed, and to stop bleeding, the studied samples of hemostatic sponges were used. Before surgery and on the 1st, 3rd, 7th, 15th, 30th day after surgery each animal was made the control dynamic laparoscopy, in which the evidence and spread of peritoneal adhesions were macroscopically evaluated. Results. In the group where Tachocomb® collagenous plate was used for arrest of bleeding, practically no statistically significant differences were found in comparison of the results of control dynamic laparoscopy (CDL) – on the 1st day after injury, there was no active bleeding and adhesions, on the 30th day a decrease in the area of growth of connective tissue structures was noted in the region of injury, and the color of parenchyma was comparable with that of intact areas. The parameters were analyzed both within the group (at different periods of the experiment) and between the experimental groups. Conclusions. In the intra-group comparison, a small number of significant differences were noted which may evidence comparability of the adhesive process at different periods of the experiment in the study groups. In practically of all cases of adhesion, they attached to the anterior abdominal wall at the point of insertion of the cannula for laparoscope (or quite close to it) that may be associated with frequent trauma of the peritoneum in this region provided by the design of the experiment, and in all cases threadlike adhesions were found, the morphological substrate of which was a strand of greater omentum. There were no clinical manifestations of adhesive intestinal obstruction in laboratory animals.

The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery.

Following breast cancer surgery, patients often require adjuvant radiation and chemotherapy for locoregional and systemic disease control. These procedures may result in postoperative complications, which may delay adjuvant therapy. To potentially decrease these complications, hemostatic agents may be used. This study evaluated the rate of postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in oncologic breast surgery with and without hemostatic agents. After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent oncoplastic breast surgery, mastectomy with or without expander/implant-based reconstruction, and subsequent reconstruction with expander to implant exchange were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL®, Ethicon, USA) or combination powder (CP, HEMOBLAST™ Bellows, biom'up, France), length of follow-up, time to JP drain removal, and post-operative complications (seroma, hematoma, or operating room (OR) takeback). This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP. The use of a hemostatic agent resulted in fewer bleeding complications and significantly decreased time until JP drain removal. Although not significant, subgroup analysis demonstrated that this was more pronounced in the CP group. JP drain duration was decreased among all procedures for CP compared to FS. The use of hemostatic agents in oncologic breast surgery may result in decreased postoperative complications and significantly reduce time to JP drain removal.

22 The clinical utility of postoperative hemoglobin and creatinine after surgery for pelvic organ prolapse

To determine the clinical utility of postoperative hemoglobin (Hb) and creatinine (Cr) testing after reconstructive surgery for pelvic organ prolapse (POP). This is a retrospective cohort study of patients who had surgery for apical prolapse between 2017 and 2019. All subjects were admitted to the hospital for overnight observation. Subjects were divided into 2 groups: symptomatic and asymptomatic. Symptomatic patients were defined as having one or more of the following: BP < 90/60, HR > 100, UOP < 30 cc/hr, subjective dizziness, unilateral flank pain, or abdominal pain. Patients with cancer, acute or chronic kidney injury and no preoperative Hb and/or Cr were excluded. Demographic, intraoperative/postoperative data, and postoperative Hb/Cr values were recorded. Hemoglobin and BMP was obtained. The cost for these at our institution is $90.00 and $450.00, respectively. Spearman correlation coefficient was used for percent change in Hb and Cr. Fisher’s exact and Mann-Whitney tests analyzed categorical and continuous data respectively. A P value <0.05 was considered significant. Analysis performed with STATA version 16. The final analysis included 325 subjects. All subjects had apical reconstructive surgery for POP. Anterior and/or posterior vaginal wall repairs were performed in 296 of total patients (91.08%). In the symptomatic and asymptomatic groups 89 and 124 had concomitant hysterectomy respectively. Anti-incontinence surgery was performed in 103 patients in the asymptomatic group and 70 patients in the symptomatic group. One hundred twenty patients (36.9%) had postoperative symptoms suggestive of anemia. Patients with symptomatic anemia had a marked decrease in POD1 Hb from preoperative Hb compared to asymptomatic patients with a mean decrease of -18.11 g/dl and -15.49 g/dl, respectively (P < 0.001). There was no significant difference in intravenous fluids (IVFs) (P < 0.85), intraoperative use of hemostatic agents (P < 0.75), or longer operative time (P < 0.08). No (n = 0) symptomatic or asymptomatic patients required transfusion. Hb testing cost in this population was $61,745. Two patients (0.61%) had postoperative symptoms suggestive of acute kidney injury including flank and abdominal pain. Patients with symptomatic acute kidney injury had a marked increase in POD1 Cr compared to asymptomatic patients with a mean increase of 0.23 g/dl and -3.07 g/dl, respectively (P < 0.05). Additionally, symptomatic patients received additional imaging (P < 0.05). One symptomatic patient with flank pain underwent reoperation. No asymptomatic patients underwent reoperation for AKI. Cr cost in this population was $131,812. Routine postoperative Hb and Cr testing after reconstructive surgery for apical POP is not clinically necessary in asymptomatic patients. Postoperative Hb and Cr should be reserved for symptomatic patients. Limiting testing for those with symptoms can reduce overall healthcare cost.

Impact of acetylsalicylic acid (ASA) on postoperative hemorrhage in spinal lumbar surgery: Should preoperative ASA be discontinued for elective surgery?

ObjectiveThe application of acetylsalicylic acid (ASA) represents high evidence in the aging society due to primary and secondary prevention in cardiovascular disease and stroke. However, this presents a challenge for neurosurgeons in terms of preoperative and postoperative management of care. This study aimed to analyze the risk of bleeding by applying ASA before lumbar spinal surgery. MethodsRetrospective analysis of medical records of 3051 patients was performed from 2008 to 2018 who underwent lumbar surgery at our institution. The risk of postoperative hemorrhage was compared in patients treated with ASA versus patients without ASA treatment. Additionally, the relationship between discontinuation of ASA preoperatively (≥7 days) or no previous history of ASA versus continuation with ASA (<7 days) on postoperative hemorrhage was analyzed. ResultsPostoperative hemorrhagic were observed in 2.1% (n = 63) of all lumbar operations. In 421 patients, the effect of ASA (<7 days) was still persistent at the time of surgery (ASA impact group). Of these, 12 (2.85%) patients had a hemorrhage. No significant differences were found in comparison to the No ASA impact group (p = 0.272). Sex (p = 0.003), hypertension (p = 0.015), recurrent surgery (p = 0.001) and use of hemostatic agents (p = 0.023) had a significant impact on postoperative hemorrhage. ConclusionThe continuation of ASA medication is not associated with increased risk of postoperative hemorrhage after spinal surgery. However, sex, hypertension, recurrent surgery and the use of hemostatic agents under continued ASA treatment were found to be associated with an increased risk of hemorrhage.

A Hemostatic Technique in Robot-Assisted Laparoscopic Partial Nephrectomy and Its Impact on Renal Function.

PurposeRobot-assisted partial nephrectomy (RAPN) has become popular in recent years for small renal masses. We describe a technique of suturing renal defects during RAPN that is reliable and quick, does not necessitate the need for hemostatic agents, and reduces perioperative complications.Materials and methodsA total of 24 patients who underwent RAPN were included in the study period between 2013 and 2018 and data were analyzed. Perioperative and postoperative outcomes were measured and compared.ResultsThe median tumor size was 4 cm. Median warm ischemia time was 41 minutes (IQR: 38-45 minutes) and estimated blood loss was 150 mL (IQR: 120-200 mL). There were no major intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed.ConclusionOur technique is safe and effective. It negates the use of hemostatic agents, decreases perioperative complications, and negates that determination of long-term renal function is not associated with prolonged warm ischemia time alone. Hence, we propose that our technique is safe in partial nephrectomy when the pelvic calyceal system and renal vessels are opened in multiple locations.

Coronavirus disease 2019: changing the future of emergency epistaxis management.

Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens.

Epidemiology of the Use of Hemostatic Agents in Children Supported by Extracorporeal Membrane Oxygenation: A Pediatric Health Information System Database Study.

Objectives: Children supported by extracorporeal membrane oxygenation (ECMO) are at high risk of bleeding. Though practitioners often prescribe blood components and/or medications to prevent or treat bleeding, the utilization of these hemostatic measures in children is not well-understood. We sought to evaluate the use of hemostatic blood products (platelet, plasma and cryoprecipitate transfusions) and medications [aminocaproic acid, tranexamic acid (TXA) and Factor VIIa] in children supported by ECMO.Design: Retrospective observational study using the Pediatric Health Information System (PHIS) database from 2011-2017.Setting: Fifty-one U.S. children's hospitals.Patients: Children (aged 0–18 years) supported by ECMO.Interventions: None.Measurements and Main Results: ECMO was employed in the care of 7,910 children for a total of 56,079 ECMO days. Fifty-five percent of the patients were male with a median (IQR) age of 0 (0–2) years. The median (IQR) length of ECMO was 5 (2–9) days with a hospital mortality rate of 34%. Platelets were transfused on 49% of ECMO days, plasma on 33% of ECMO days and cryoprecipitate on 17% of ECMO days. Twenty-two percent of children received TXA with the majority receiving it on the first day of ECMO and the use of TXA increased during the 6-year period studied (p < 0.001). Seven percent of children received aminocaproic acid and 3% received Factor VIIa.Conclusions: Children supported by ECMO are exposed to a significant number of hemostatic blood products. Antifibrinolytics, in particular TXA, are being used more frequently. Given the known morbidity and mortality associated with hemostatic blood products, studies are warranted to evaluate the effectiveness of hemostatic strategies.

746 COVID-19: Changing the Future of Emergency Epistaxis Management

IntroductionAcute epistaxis can be a life-threatening airway emergency. Therefore, the majority of patients in whom conservative management (including cautery) has failed are admitted. However, due to the COVID-19 pandemic, our management has shifted towards a more outpatient centred approach.MethodA single centre retrospective study was undertaken of all epistaxis patients managed by the ENT team at our centre over a five-month period from 1st January to 31st May 2020. The first 10 weeks (Pre-COVID-19) were managed using pre-existing guidelines. The following 10 weeks (COVID-19) were managed using the new COVID-19 standard operating procedures which aimed to minimise inpatient admissions.Results142 patients, with similar demographic data, were seen across the 5-month period. There were significantly more patients aged over 65 presenting in the COVID-19 group (p = 0.04). There was a significantly increased use of local haemostatic agents (Nasopore ® and Surgiflo ®) and decreased use of nasal packing in the COVID-19 group. There were significantly fewer admissions (p < 0.0005) in the COVID-19 group, but similar rates of representation, length of stay and morbidity.ConclusionsThe COVID-19 pandemic has accelerated the shift towards the use of local haemostatic agents and outpatient management of epistaxis, which is as safe and effective as previously well-established epistaxis management.

Adhesion barriers and topical hemostatic agents are risk factors for post-cesarean section infections

BackgroundCesarean sections are the most common surgery worldwide, and post-cesarean section infections and hemorrhage are a major cause for morbidity and mortality. In recent years, many surgeons use adhesion barriers as well as hemostatic agents during primary and repeated cesarean section. The data regarding the safety of these agents is relatively limited. The objective of this study was to investigate whether the use of adhesion barriers and topical hemostatic agents pose a risk for post-cesarean section infections. MethodA case-control study composed of women who were admitted to the Soroka University Medical Center between the years 2012 and 2016 was conducted. The study group was composed of women admitted owing to post-cesarean section infections (cases) and those who underwent cesarean sections without post-cesarean section infection (control subjects). Matching was done according to date and surgery setting (elective versus emergency). A univariate analysis was followed by a multiple regression model in order to examine the association between adhesion barriers/hemostatic agents and post-cesarean section infections. ResultsDuring the study period, 113 patients developed postoperative infection (cases); 71.7% were diagnosed with surgical site infection, 7.1% with endometritis, and 21.2% with other infections. These were compared with 226 control subjects. In the univariate analysis, the use of adhesion barriers/hemostatic agents were found to be associated with post-cesarean section infection. Using a multivariable analysis controlling for previous cesarean section, skin closer technique, preterm delivery, and duration of surgery >60 minutes, the use of adhesion barriers as well as hemostatic agents was found to be independently associated with post-cesarean section infection (adjusted odds ratio = 2.11, 95% confidence interval = 1.17–3.84; adjusted odds ratio = 2.29, 95% confidence interval = 1.37–3.8, respectively) ConclusionAdhesion barriers and hemostatic agents were found to be independently associated with post-cesarean section infections. Further larger studies are needed to reinforce our findings. The use of these materials should be carefully considered, and their cost-effectiveness re-examined.

Fungal Chitosan-Derived Biomaterials Modified with Kalanchoe pinnata as Potential Hemostatic Agents-Development and Characterization.

Massive blood loss is still a great challenge for modern medicine. To stop the hemorrhage during the surgery or after injury apart from suturing or electrocoagulation, the most efficient method of hemostasis restoration is the use of hemostatic agents. Although there are numerous products on the market, there is still a need for biomaterials that are capable of fast and efficient bleeding management without affecting wound closure or embolism. Chitosan is known for its hemostatic activity; however, its quite poor mechanical properties and heterogenous chemical composition still needs some improvements to become superior compared to biological adhesives. The following study deals with the preparation and evaluation of chitosan-derived natural biomaterials containing Kalanchoe pinnata extract with the potential application as a blood-clotting agent. The materials were obtained under microwave-assisted conditions in two different forms (granules/dressing), whose chemical structure and morphology were studied. Their antioxidant properties have been proven. The chitosan-derived hemostatic agents exhibited superior blood sorption abilities and lack of cytotoxicity to L929 mouse fibroblasts. The study also showed the differences in biological properties depending on their preparation method. The potential mechanism of action was proposed as well as their potential in hemostasis revival.

Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery.

Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.

Prophylactic use of dural tenting sutures in elective craniotomies in adults\u2014is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial

BackgroundIn 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.MethodsThis 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.DiscussionIt 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 disseminationThe 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. s will be submitted to relevant national and international conferences.Trial statusProtocol version and date: version 1.5, 14.01.2020First recruitment: September 7, 2018Estimated recruitment completion: September 1, 2021

Anaphylaxis after injecting a hemostatic agent containing gelatin into vertebral bone under pressure-a warning.

Case series. The use of topical hemostatic agents is common in spinal deformity surgery. While beneficial, emerging case data shows gelatin-containing agents causing intra-operative complications. We present two patients who developed anaphylaxis after injection of these gelatin-containing hemostatic agents into the vertebral body using manual pressure. In the literature, while anaphylactic reactions associated with the use of animal-derived gelatin has been implicated; the risk of injecting these products into the closed vascular cavity of the vertebral body with subsequent embolization into systemic circulation bears emphasis. This report is to meant to make the surgical team aware of the risks of injecting hemostatic agents using manual pressure into the vertebral body and to highlight a plausible mechanism for the phenomenon. Two children with spinal deformity undergoing posterior spinal fusion procedures with the use of gelatin-containing hemostatic agents injected into the vertebral body through the pedicle are described. Both patients had gelatin-containing hemostatic agent solution injected under manual pressure through the vertebral pedicle to prevent excessive bleeding. Anaphylaxis occurred soon thereafter, resulting in emergent cessation of the surgery and initiation of medical resuscitation. In both cases, tryptase levels obtained just after the event were elevated. Patients with an allergy to or prior history of exposure to zoologic products undergoing spine surgery may be at risk of anaphylaxis if the gelatin-containing hemostatic agent is injected under manual pressure into the closed space of the vertebral body. This allows rapid entry into the venous circulation. We recommend that the surgeon perform a thorough history of a patient's allergies and use extreme caution when injecting these topical hemostatic products into the vertebral body. IV.

Autologous fibrin sealant application in cardiac surgery - a single-centre observational study.

IntroductionTo minimize the risk of blood loss and post-transfusion complications in patients undergoing cardiovascular surgery, different strategies are used.AimTo analyse the efficacy of the intraoperative use of autologous fibrin glue to seal suture lines of cardiac and vascular structures.Material and methodsThe early results of 62 patients who underwent complex cardiac operations in extracorporeal circulation were analysed. In a half of them Vivostat autologous fibrin sealant in addition to the routine haemostatic agents was applied (study group), whereas in the second group (matched-pair control group) only standard haemostatics were used. Among many other factors, special attention was paid to postoperative drainage and blood products used.ResultsThe mean age of the patients and prevalence of comorbidities did not differ between groups. Generally, in the study group fewer haemostatic agents were used. For example, Preveleak tissue glue was applied in 3.2% of studied cases compared to one third of control patients (p = 0.008). The thoracic drainage on either day 0 or day 1 was also similar. The number of patients who received blood products did not differ between groups. More importantly, there were no significant differences in in-hospital mortality and prevalence of other postoperative complications.ConclusionsIn this study it was found that application of autologous fibrin glue was safe and might limit use of standard haemostatic agents. Taking into account the lack of potential threats related to the transmission of infections and immune responses, it may be an interesting alternative to the previously used local haemostatics.

Lysine analogue use during cancer surgery: a survey from a Canadian tertiary care centre.

When used during surgery, antifibrinolytic hemostatic agents such as lysine analogues are effective at reducing blood loss and the need for transfusions. Despite proven efficacy, use of hemostatic agents remains low during some surgeries. Our objective was to explore surgeon opinions about, and use of lysine analogues in, oncologic surgeries at a large tertiary care academic institution. We administered a survey to surgeons who perform high-transfusion-risk oncologic surgeries at a large academic hospital in Ottawa, Ontario. Design and distribution of the survey followed a modified Dillman method. To ensure that the survey questionnaire was relevant, clear, and concise, we performed informant interviews, cognitive interviews, and pilot-testing. The final survey consisted of 19 questions divided into 3 sections: respondent demographics, use of hemostatic agents, and potential clinical trial opinions. Of 28 surgeons, 24 (86%) participated. When asked to indicate the frequency of lysine analogue use, "never" accounted for 46% of the responses, and "rarely" (<10% of the time) accounted for 23% of the responses. Reasons for never using included "unfamiliar with benefits" and "prefer alternatives." Fifteen surgeons (63%) felt that a trial was needed to demonstrate the efficacy and safety of lysine analogues in their cancer field. Our survey found that lysine analogues are infrequently used during oncologic surgeries at our institution. Many surgeons are unfamiliar with the benefits and side effects of lysine analogues and, alternatively, use topical hemostatic agents. Our results demonstrate that future trials exploring the efficacy and safety of lysine analogues in oncologic surgery are needed.

Current Practice in FFP Preparation and Use in Greece: A National Survey

Objective:Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece.Materials and Methods:The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed.Results:According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals.Conclusion:This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.