Use Of Hemostatic Agents Research Articles

Treatment of Renal Capsule Lesion in a Transplanted Kidney: A Case Report and Literature Review

Expanded donor criteria have been established to reduce organ wastage, as various factors can lead the disposal of kidneys, such as anatomical abnormalities, traumatic injuries, and iatrogenic injuries during organ retrieval surgery. We report a case of kidney transplantation in which a capsular lesion was identi!ed and repaired during organ preparation (back table) and review of the literature regarding transplant kidney injuries. A diabetic and hypertensive 52-year-old patient with chronic kidney disease undergoing dialysis therapy for 2 years was admitted for a deceased donor kidney transplant. "e donor was a 35-year-old man with brain death secondary to traumatic brain injury in a car accident. During the kidney preparation on the back table, a capsular lesion was visualized on the upper pole of the right kidney. Continuous suture of the renal capsule was performed using a 3-0 CatGut suture to correct the defect and reconstruct the renal surface. After renal reperfusion, no active bleeding was observed from the sutured area. "e patient had a good postoperative course with no complications. "e main complications associated with capsular lesions and complete capsular denudation are bleeding and hematoma formation, as well as urinary and lymphatic extravasation through the exposed renal parenchyma. Treatment may involve direct cauterization using electrocautery or argon plasma, or the use of hemostatic agents. Successful repair of capsular lesions not only prevents complications such as bleeding during reperfusion and urinary !stulae but also plays a crucial role in expanding the pool of organs available for transplantation.

The Role of Video Thoracoscopy in the Diagnosis of Sarcoidosis

Sarcoidosis is a systemic autoimmune disease associated with the development of non-caseous granulomas. Early and accurate diagnosis of sarcoidosis is an important and difficult task, since the initial manifestations are diverse, nonspecific, and many patients are asymptomatic. Objective — to study the role of video thoracoscopy and to present our own experience of invasive diagnosis of sarcoidosis. Materials and methods. Patients included in the study were divided into 2 clinical groups depending on whether the diagnosis at admission coincided with the final diagnosis established after the morphological examination of lung biopsies or not. Group I — 74 patients with PDS and ML (41.6 %), whose diagnosis at admission coincided with the final clinical diagnosis (established on the basis of morphological examination of lung biopsies). Group II — 104 patients with PDS and ML (58.4 %), whose diagnosis upon admission did not coincide with the final clinical diagnosis. Results and discussion. Insufficient diagnosis of lung cancer (lung carcinomatosis) — 3 (2.9 %) cases at admission and 31 (29.8 %) cases after lung biopsy. The small percentage of diagnosis of interstitial, granulomatous lesions of the lungs or pneumonitis with systemic connective tissue pathology is also noteworthy - 3 (2.9 %) cases before lung biopsy and 19 (18.3 %) after. In patients who were diagnosed with pulmonary sarcoidosis without histological confirmation, such a pathology as tuberculosis was found in 14 (13.5 %), oncological lesion — 23 (22.1 %), interstitial or granulomatous lesion together with pneumonia in systemic pathology — 17 (16.3 %) and «other» — 20 (19.2 %) cases. We performed 178 VATS biopsies, among which lung biopsy prevailed — 67 (37.6 %) cases, pleural biopsy was the least performed — 18 (10.1 %) cases. Intraoperative complications were recorded in 2 (1.1 %) cases, in the form of bleeding from a lymph node, the elimination of which required the use of electrocoagulation, the use of local and systemic hemostatic agents. Postoperative complications were observed in 5 (2.8 %) cases and were caused by the lack of lung tightness and the resulting long-term discharge of air through the drainage. Conclusions. Manifestations of sarcoidosis often simulate other disseminated processes, so its invasive diagnosis is an effective and safe way of establishing the diagnosis, especially in complex cases and atypical clinical and radiological picture. Among invasive methods, preference should be given to mini-invasive methods, therefore, the optimal choice is VATS, which has high informativeness and a low percentage of postoperative complications and allows to evaluate a wide range of tissues such as the pleura, lymph nodes and lungs.

Gelfoam Granuloma Mimicking Brain Abscess Following Decompressive Craniotomy

AbstractThe use of adjuvants in brain surgery has increased. Artificial adjuncts are being used in neurosurgery frequently. These foreign materials may result in a foreign body reaction inside the normal brain tissue surrounding the areas of pathology. This material may mimic an abscess or tumor in their presentation and masquerade the magnetic resonance (MR) or computed tomography (CT) image as recurrence, abscess, or granuloma. We present a case of a 42-year-old woman with a history of hypertensive basal ganglia bleeding who was operated on in an emergency. Decompressive craniectomy and clot evacuation were carried out. A thin layer of Gelfoam was applied in the operated area. After 4 weeks, she was planned for cranioplasty where an oval soft to firm yellowish lesion was found at the site of the previous cavity of the evacuated clot, which was sent for biopsy and it was confirmed as a Gelfoam granuloma. Meticulous use of hemostatic agents in the form of small surgical or thin waferlike gelatin sponges should be used intraoperatively. Large-size Gelfoam and artificial agents can lead to foreign body–like granulation tissue formation in normal brain tissue and several complications like hydrocephalous, meningitis, and seizures. Peculiarities in this case include the following: Gelfoam granuloma is a very rare complication following cranial surgery, it was mimicking like an abscess, and the size of Gelfoam used intraoperatively should be a thin wafer coating the raw surface or in the cavity.

Cryopreserved nanostructured fibrin-agarose hydrogels are efficient and safe hemostatic agents

Uncontrolled bleeding during surgery is associated with high mortality and prolonged hospital stay, necessitating the use of hemostatic agents. Fibrin sealant patches offer an efficient solution to achieve hemostasis and improve patient outcomes in liver resection surgery. We have previously demonstrated the efficacy of a nanostructured fibrin-agarose hydrogel (NFAH). However, for the widespread distribution and commercialization of the product, it is necessary to develop an optimal preservation method that allows for prolonged stability and facilitates storage and distribution. We investigated cryopreservation as a potential method for preserving NFAH using trehalose. Structural changes in cryopreserved NFAH (Cryo-NFAH) were investigated and comparative in vitro and in vivo efficacy and safety studies were performed with freshly prepared NFAH. We also examined the long-term safety of Cryo-NFAH versus TachoSil in a rat partial hepatectomy model, including time to hemostasis, intra-abdominal adhesion, hepatic hematoma, inflammatory factors, histopathological variables, temperature and body weight, hemocompatibility and cytotoxicity. Structural analyses demonstrated that Cryo-NFAH retained most of its macro- and microscopic properties after cryopreservation. Likewise, hemostatic efficacy assays showed no significant differences with fresh NFAH. Safety evaluations indicated that Cryo-NFAH had a similar overall profile to TachoSil up to 40 days post-surgery in rats. In addition, Cryo-NFAH demonstrated superior hemostatic efficacy compared with TachoSil while also demonstrating lower levels of erythrolysis and cytotoxicity than both TachoSil and other commercially available hemostatic agents. These results indicate that Cryo-NFAH is highly effective hemostatic patch with a favorable safety and tolerability profile, supporting its potential for clinical use.

Clearing the Smoke: The Evidence behind Risk of Electrocautery Smoke and Mitigation Strategies.

Electrocautery has been a useful, fundamental instrument utilized for surgical procedures since its implementation in the 1920s. However, concerns exist regarding the health hazards of the by-product smoke associated with the use of electrocautery. A comprehensive review of articles on the composition, mitigation, and effects of smoke was conducted using the PubMed search engine and excluding articles that did not meet the predetermined inclusion criteria. From January 1963 to December 2021, a total of 264 articles resulted, and a total of 69 articles were included in this narrative review. Surgical smoke contains volatile organic compounds, polycyclic aromatic compounds, viral particles, and ultrafine particles. There has been some evidence of mutagenicity to bacterial cells during animal in vivo studies, and one human survey study has shown similar mutagenic effects. We also discuss additional hemostatic techniques that can be used, including the use of hemostatic and antithrombolytic agents, epinephrine infiltration, and the use of tourniquet when appropriate. Further studies should be conducted regarding human effects, but until the data are available, we recommend precautionary measures and actions to protect operating room staff from cautery smoke exposure.

Bloodless Cardiac Surgery in Jehovah's Witness: A Comprehensive Review.

This article explores the major challenges and specialized strategies involved in managing cardiovascular surgery patients who are Jehovah's Witnesses and refuse blood transfusions due to their religious beliefs. It delves into preoperative, intraoperative, and postoperative approaches aimed at minimizing blood loss and optimizing patient outcomes while respecting their autonomy. Preoperative measures focus on correcting anemia and coagulopathy through targeted interventions, such as iron supplementation and erythropoietin therapy, and meticulous screening for bleeding disorders. Intraoperative techniques include the use of vasoconstrictors, hemostatic agents, and innovative blood conservation methods like acute normovolemic hemodilution and cell salvage. Postoperative care emphasizes infection control, hemostasis, and judicious monitoring to prevent anemia and facilitate recovery. Through a multidisciplinary approach and adherence to evidence-based practices, healthcare providers can effectively meet the needs of Jehovah's Witness patients, ensuring safe and successful cardiovascular surgery outcomes without the use of blood transfusions.

TAVAC: comprehensive review of currently available hemostatic products as adjunct to surgical hemostasis.

The use of hemostatic agents by general surgeons during abdominal operations is commonplace as an adjunctive measure to minimize risks of postoperative bleeding and its downstream complications. Proper selection of products can be hampered by marginal understanding of their pharmacokinetics and pharmacodynamics. While a variety of hemostatic agents are currently available on the market, the choice of those products is often confusing for surgeons. This paper aims to summarize and compare the available hemostatic products for each clinical indication and to ultimately better guide surgeons in the selection and proper use of hemostatic agents in daily clinical practice. We utilized PubMed electronic database and published product information from the respective pharmaceutical companies to collect information on the characteristics of the hemostatic products. All commercially available hemostatic agents in the US are described with a description of their mechanism of action, indications, contraindications, circumstances in which they are best utilized, and expected results. Hemostatic products come with many different types and specifications. They are valuable tools to serve as an adjunct to surgical hemostasis. Proper education and knowledge of their characteristics are important for the selection of the right agent and optimal utilization.

Hemostatic agent use in minimally invasive hysterectomies: complications and cost

Hemostatic agent use in minimally invasive hysterectomies: complications and cost

Same-Day Discharge for Pediatric Hemithyroidectomy Patients: Evaluating Safety and Barriers to Discharge.

Hemithyroidectomy is often performed in the pediatric population for indeterminate or benign thyroid nodules. Prior studies confirmed the safety of same-day discharge for adults undergoing hemithyroidectomy or total thyroidectomy, but this has not been studied thoroughly in the pediatric population. Our goal was to determine differences in pediatric patients undergoing hemithyroidectomy who were admitted versus discharged for complications or factors to support same-day discharge. Retrospective cohort. Pediatric tertiary care hospital. This was a retrospective study of pediatric patients (0-18 years of age) undergoing hemithyroidectomy at a pediatric tertiary care hospital from 2003 to 2022. Perioperative variables and outcomes were gathered via manual chart review. One hundred five pediatric patients who underwent hemithyroidectomy were identified. Ninety (86%) patients were admitted postoperatively, and 15 (14%) were discharged the same day. There were no differences in patient demographics, including age (P = 0.29) distance from the hospital (P = 0.08) or benign versus malignant pathology (P = 0.93). Surgical time in same-day discharges was significantly shorter (P = 0.0001; 138.6 minutes, SD = 66.0) versus admitted patients (204.2 minutes, SD = 48.6) Hemostatic agents were used more in same-day discharges at 53.3% versus 4.5% (P = 0.0001). Perioperative complications occurred in 2 (2.2%) admitted patients compared to none in the same-day discharge (P = 1.0). There were no readmissions within 30 days for same-day discharges. In pediatric patients undergoing uncomplicated hemithyroidectomy, same-day discharge appears appropriate for those with shorter surgical times and intraoperative use of hemostatic agents with no readmissions or complications in those discharged the same day.

Synthetic Haemostatic Sealants: Effectiveness, Safety, and In Vivo Applications.

Rapid haemostasis during surgery is essential when one wants to reduce the duration of operations, reduce the need for transfusions, and above all when one wants to achieve better patient management. The use of haemostatic agents, sealants, and adhesives improves the haemostatic process by offering several advantages, especially in vascular surgery. These agents vary widely in their mechanism of action, composition, ease of application, adhesion to wet or dry tissue, immunogenicity, and cost. The most used are cyanoacrylate-based glues (Glubran 2) or polysaccharide hydrogel-microsphere powder (AristaTMAH). This work is based on a retrospective study carried out on a sample of patients with different vascular diseases (FAV, pseudoaneurysm, and PICC application) in which two different haemostatic sealants were used. The aim was to assess the safety, the advantages, and the ability of both sealants to activate the haemostatic process at the affected site, also in relation to their chemical-physical characteristics. The obtained results showed that the application of Glubran 2 and AristaTMAH as surgical wound closure systems is effective and safe, as the success achieved was ≥94% on anastomoses of FAV, 100% on stabilization of PICC catheters, and ≤95% on pseudoaneurysms.

Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries

Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.

Surgical Outcome of Tumescent Versus Non Tumescent Technique for Harvesting Split Skin Graft: A Prospective Cohort Study

Introduction: The technique for harvesting Split-thickness Skin Grafts (STSG) varies among surgeons. To control bleeding from split-thickness skin graft donor sites, the use of several haemostatic agents has been reported. The tumescent technique involves injecting tumescent fluid into the subcutaneous fat, obtaining swelling and firmness (tumescence) of the surgical area. This creates regional anaesthesia of the skin and subcutaneous tissue, allowing painless cutaneous surgery, with adrenaline acts as a haemostatic agent. Aim: To compare the surgical outcomes in terms of blood loss during the harvesting of STSG, postoperative pain experienced by the patient, healing of the donor site, and graft take rate with tumescent versus non tumescent techniques of STSG. Materials and Methods: The present prospective cohort study was conducted in the Department of General Surgery, M S Ramaiah Medical College, Bengaluru, Karnataka, India, from November 2017 to March 2019. A total of 56 patients were enrolled after applying inclusion and exclusion criteria. Patients were alternately assigned into the groups of tumescent or non tumescent technique groups. Intraoperative bleeding was assessed, postoperative pain was assessed using the Visual Analogue Score (VAS), and healing of the donor and recipient sites were assessed. Student’s t-test (two-tailed, independent) was used to find the significance of study parameters on a continuous scale between the two groups. The Chi-square/ Fisher’s-exact test was used to assess the significance of study parameters on a categorical scale between two or more groups. Results: The mean±Standard Deviation (SD) age of patients in the tumescent group was 48.25±12.79 years and in the non tumescent group was 52.79±12.91 years. Intraoperative bleeding ranged from 0-25% in all 28 patients in the tumescent group, while it ranged from 76-100% in all 28 patients in the control group (p-value<0.001). When the authors compared the pain on Postoperative Day (POD) 1 using VAS we observed that 32.1% of cases (n=9) had a score of 5-7 compared to 28.6% of controls (n=8). There was no significant difference in postoperative pain, and the technique used for harvesting STSG did not affect the healing of the donor site or the graft take at the recipient site. Conclusion: The tumescent technique is a safer and better alternative to the non tumescent technique, as intraoperative bleeding is significantly lower with the former. Additionally, the tumescent technique does not affect the healing of the donor or recipient site.

Aortic annulus rupture after transcatheter aortic valve replacement: successful management of a dangerous complication

ObjectiveAortic annulus rupture remains one of the most fatal complications of TAVR. While attempts have been made to describe and predict this complication, the data remains insufficient without evidence-based guidelines for management of this rare complication.MethodsHere we describe a series of 3 aortic annulus ruptures after TAVR which were managed successfully to hospital discharge.ResultsPatient 1 suffered annulus rupture during balloon valvuloplasty prior to TAVR. The patient became hypotensive, and echocardiogram showed pericardial effusion. The patient underwent pericardiocentesis which transiently improved the blood pressure, but bleeding continued. The patient was transitioned to an open surgical aortic valve replacement due to ongoing hemorrhage. The chest was left open with delayed closure on post-op day 2. The patient was discharged on post-op day 15. Patient 2 was undergoing TAVR valve expansion. The patient became hypotensive. An echocardiogram revealed pericardial effusion. Pericardiocentesis yielded 200 mL of blood. SURGIFLO (Johnson & Johnson Wound Management, Somerville, NJ) was injected into the pericardial space. Aortic root angiography confirmed no further contrast extravasation. A pericardial drain was left in place for 2 days, and the patient was discharged on post-op day 7. Patient 3 received a TAVR valve and post-placement dilation due to paravalvular leak. The echocardiogram showed a pericardial effusion. Pericardiocentesis was performed, yielding 500 cc of blood. The patient’s healthcare proxy declined emergent surgery; thus, a pericardial drain was placed. No hemostatic agents were used, and drainage reduced over several hours. The drain was removed on post-op day 3, and the patient was discharged on post-op day 8.ConclusionsBased on the timelines in these three cases, and interventions used, the following steps may be employed in the event of annulus rupture: identification of hemodynamic instability, echocardiogram to confirm pericardial effusion, emergent pericardiocentesis, pericardial drain placement for evacuation of the pericardial space and use of hemostatic agents, repeat aortogram to rule out ongoing extravasation. If hemostasis is unable to be achieved and/or the patient becomes hemodynamically unstable at any point, rapid transition to emergent surgical management is necessary. This management strategy proved successful for this case series and warrants further investigation.

EP07.01-09 Can the Use of New Haemostatic Agent Improve Short Term Outcomes of Surgically Treated Non-small Cell Lung Cancer Patients?

EP07.01-09 Can the Use of New Haemostatic Agent Improve Short Term Outcomes of Surgically Treated Non-small Cell Lung Cancer Patients?

Hemostatic Efficacy of Oxidized Regenerated Cellulose Powder in Le Fort 1 Osteotomy.

A challenging aspect of Le Fort I osteotomy is bleeding control. Osteotomy techniques, devices, drugs, and anesthetic management have been reported to reduce bleeding; however, there are no reports on the use of hemostatic agents. We aimed to evaluate the hemostatic efficacy of a new topical absorbent hemostatic agent, Surgicel Powder, consisting of oxidized regenerated cellulose (ORC). We reviewed the records of 40 patients who underwent Le Fort I surgery for jaw deformities, with or without cleft lip and palate. Twenty of the 40 patients did not have cleft lips or cleft palates (CLCP); the remaining 20 had CLCP. In each group, an absorbent hemostatic agent was used in 10 patients but not in the other 10. Total blood loss and operative time for each group were evaluated. In the jaw deformity without CLCP group, the amount of bleeding with or without ORC was 112.0±33.8 and 158.6±75.3mL, respectively, with a significant difference between groups ( P <0.05). Operative time with or without ORC was 206.4±31.3 and 238.3±42.5 minutes, respectively, with a significant difference observed between groups ( P <0.05). In the jaw deformity with CLCP group, the amount of bleeding with or without ORC was 199.7±64.6 and 476.8±104.8mL, respectively, with a significant difference between groups ( P <0.05). Operative time with or without ORC was 213.7±27.6 and 220.8±41.5 minutes, respectively, with no significant difference between groups ( P =0.329). In conclusion, oxidized regenerated cellulose powder may be a beneficial hemostatic agent for reducing blood loss during Le Fort I osteotomy.

Comparison of Postoperative Complications Between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy

To compare postoperative complications of laparoscopic myomectomy (LM) with total laparoscopic hysterectomy (TLH). A secondary outcome examined whether complications differ by age. A retrospective cohort study. A multicenter academic healthcare system. Individuals > 18 years old undergoing LMfrom 2011 to 2021 or TLH for benign indications from 2020 to 2021. LM or TLH. There were 1178 patients in the LM group and 1304 in the TLH group. Patients who underwent LM were younger, more often premenopausal, nonsmokers, with lower body mass index, lower preoperative hemoglobin, larger uterine size, and lower American Society of Anesthesiologists class. LM had longer operative times (154.1 ± 74.5 vs 145.9 ± 70.5 min, p <.0001), higher use of intraoperative hemostatic agents (25% vs 9.1%, p <.0001), and higher estimated blood loss (222.7 ± 313.0 vs 87.4 ± 145.9 mL, p <.0001) than TLH. Postoperatively, LM was associated with fewer surgical site infections (3.1% vs 5.8%, p <.0001), readmissions within 30 days (2.0% vs 5.6%, p <.0001), or emergency department visits within 90 days (10.9% vs 14.4%, p=.008). LM were more likely to be admitted 24 hours postoperatively (5.9% vs 3.4%, p=.0023) or receive a blood transfusion within 30 days (4.0% vs 1.0%, p <.0001). Variables associated with increased risk of postoperative complications were tobacco use, American Society of Anesthesiologists class > 3, preoperative anemia, estimated blood loss ≥ 150 mL, and specimen weight > 250 g. Logistic regression demonstrated that operative time ≥185 minutes was most strongly associated with 24-hour admission postoperatively (odds ratio [OR]=12.95; 95% confidence interval [CI], 3.71-45.27). In individuals ≤ 37 years of age, the LM group was less likely than the TLH group to experience surgical site infection (OR, 0.30; 95% CI, 0.14-0.62) or present to the emergency department (OR, 0.40; 95% CI, 0.26-0.63). In this large cohort of patients, both LM and TLH had low rates of postoperative complications, but the complications differed for each approach. In appropriate surgical candidates, either approach may be offered based upon patients' goals.

Acquired haemophilia A: A 15-year population-based review of incidence rate, patient demographics and treatment outcomes.

Acquired haemophilia A (AHA) is a rare bleeding disorder characterized by autoantibodies against coagulation factor VIII (FVIII). Estimates of AHA incidence are largely based on registry data, which may be prone to referral bias. Population-based studies can enhance our understanding of the epidemiology, presentation and outcomes of AHA. We conducted a retrospective, population-based cohort study of all AHA diagnosed and treated in Manitoba, Canada over a 15-year period. Using records from the sole provincial reference laboratory, we identified all patients with FVIII inhibitors who did not have congenital haemophilia. Using a piloted case report form, patient data was ascertained from hospital and bleeding disorder clinic records. From 2006 to 2021, we identified 34 patients with AHA, corresponding to a population-based incidence rate of AHA of 1.78 cases per million per year. The median age at presentation was 76 years and most cases were idiopathic (79%). Almost all patients (97%) presented with bleeding, of which 58% were considered major bleeds and required haemostatic agents in 67%. Longstanding unexplained bleeding symptoms were commonly reported, suggesting delayed diagnosis. Immunosuppressive therapy (IST) was administered in 88% of patients. Remission was achieved in 79% of patients; median time to remission was 2.1 months. There were two deaths due to bleeding. No deaths due to IST were reported. The population-based incidence of AHA in Manitoba is 1.78 cases/million/year. Bleeding is common and can be life-threatening. AHA outcomes are encouraging with the use of haemostatic agents and IST. Serious treatment-associated morbidity and mortality is uncommon.

Effectiveness of prophylactic pharmacological hemostatic agents for reduction of blood loss at vaginal surgery: a systematic review and meta-analysis.

The objective was to evaluate the effectiveness of pharmacological hemostatic agents in the reduction of blood loss at vaginal surgery. A systematic review of randomized control trials (RCTs) was completed. We searched PubMed (1946-2022), Embase, and CINAHL, using search terms related to vaginal hysterectomies and reconstructive surgeries combined with peri-operative use of hemostatic agents. RCTs comparing hemostatic interventions with placebo or with standard care were analyzed with the primary outcome of estimated blood loss. Secondary outcomes included peri-operative complications, length of stay, blood transfusion, and readmission. Risk of bias was assessed using the Risk of Bias 2 tool. Nine RCTs were included with a total of 903 participants. All trials were considered to have an overall low risk of bias. Meta-analysis of six RCTs (491 participants) favored the use of vasoconstrictive agent (vasopressin/ornipressin) at the surgical site for an overall effect estimate of decreased blood loss by 70ml (95% CI -125, -14ml). There was significant heterogeneity of studies with both dose and technique of vasoconstrictive agents used. Only one RCT evaluated tranexamic acid and found a benefit in the prophylactic use of intravenous tranexamic acid. Peri-operative use of vasoconstrictive agents slightly reduces bleeding in women undergoing elective vaginal surgery. Additional studies evaluating alternative pharmacological agents such as tranexamic acid may be of benefit.

The effect of different hemostatic agents following dental extraction in patients under oral antithrombotic therapy: a network meta-analysis

This network meta-analysis was done to thoroughly evaluate the available literature on the use of different hemostatic agents for dental extraction in patients under oral antithrombotic therapy, aiming to identify the agent with the best/worst performance in bleeding control. Considering that such patients have a higher risk of bleeding, choosing the right hemostatic is essential. Twenty-three randomized clinical trials articles were included after completing the literature search. Cyanoacrylate tissue adhesive showed a reduction in the odds of postoperative bleeding events compared with conventional methods (i.e., gauze/cotton pressure, sutures), with a tendency toward a statistical significance (OR 0.03, P = 0.051). Tranexamic acid was the only agent that demonstrated a significantly lower risk of developing postoperative bleeding events (OR 0.27, P = 0.007). Interestingly, chitosan dental dressing and collagen plug had the shortest time to reach hemostasis. However, they ranked last among all hemostatic agents, regarding bleeding events, revealing higher odds than conventional measures. Therefore, it is concluded that the use of cyanoacrylate tissue adhesive and tranexamic acid gives favorable results in reducing postoperative bleeding events following dental extractions. Although chitosan dental dressing and collagen exhibited a faster time to reach hemostasis, they led to a higher occurrence of bleeding events.

Trends, Cost, and Predictors of Local Hemostatics Use in Major Urological Surgery.

The national usage and cost trends associated with hemostatic agents in major urologic procedures remain unknown. This study aims to describe the trends, costs, and predictors of local hemostatic use in major urologic surgeries. We utilized the Premier Healthcare Database to analyze 385,261 patient encounters between 2000 and 2020. Our primary objective was to describe the usage patterns of topical hemostatic agents in open and laparoscopic/robotic major urological surgeries. The data from the last 5 years (2015-2020) were used to characterize specific cost trends, and multivariable regression analysis was performed to identify predictors of hemostatic agent use in relation to surgical approach, patient, and hospital characteristics. By 2020, at least 1 topical hemostatic agent was used in 37.3% (95% CI: 35.5-39.1) of laparoscopic/robotic prostatectomies and 30.7% (95% CI: 24.2-37.1) of open prostatectomies; 60.8% (95% CI: 57.6-64.1) of laparoscopic/robotic partial nephrectomies and 55.9% (95% CI: 47.3-64.5) of open partial nephrectomies; 40.7% (95% CI: 36.9-44.3) of laparoscopic/robotic radical nephrectomies and 43.2% (95% CI: 38.8-47.6) of open radical nephrectomies; and 40.52% (95% CI: 35.02-46.02) of open radical cystectomies. For the 2015-2020 cohort, predictors for hemostatic agent use varied by surgery type and included gender, race, surgical approach, insurance coverage, geographical location, urbanicity, and attending volume. The cost of the hemostatic agent accounted for less than 1.6% of the total cost of hospitalization for each procedure. The use of hemostatic agents in major urologic surgeries has grown over the past 2 decades. For all procedures, the specific cost of using a hemostatic agent constitutes a small fraction of the total hospitalization cost and does not vary significantly between open and laparoscopic/robotic approaches. Some patient, surgeon, and hospital characteristics are highly correlated with their use.