Use Of Local Hemostatic Agents Research Articles

Effectiveness of use of local hemostatic agents for external bleeding by visiting ambulance teams

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

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.

Bleeding from lumbar ventral epidural venous plexus managed with hemostatic agent from oxidized non-regenerated cellulose

Bleeding from epidural blood vessels may be an unpleasant complication during surgery of the lumbar spine, which is often difficult to manage with electrocoagulation. The use of local hemostatic agents is apossible solution. This paper presents the first experience with an agent of oxidized non-regenerated cellulose. The agent of oxidized non-regenerated cellulose was used in 21 patients (12 women and 9 men) to stop bleeding from the ventral epidural lumbar venous plexus. It was always removed before the end of the operation. In all cases, bleeding was stopped within 2 minutes. Bleeding did not recur until the end of surgery (even after removal of the agent). No early or other complications were observed in the patients studied. The agent of oxidized non-regenerated cellulose appears to be arational and effective solution for bleeding from epidural veins in the lumbar spine.

Anticoagulation Use prior to Common Dental Procedures: A Systematic Review

Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.

Experimental assessment of efficiency of new domestic local haemostatic means on the basis of chitosan

One of the main reasons for the death of potentially wounded military personnel on the battlefield is ongoing bleeding. In recent years, with the advent of a new group of local hemostatic drugs, the results of prehospital care with external massive bleeding have improved significantly. At the same time, local haemostatic agents based on chitosan showed the greatest effectiveness. The results of the experimental evaluation of the effectiveness of new local haemostatic agents based on chitosan: «Gemohit» (powder, 20 g in the package) and «Hemohit-bandage» (a bandage in the z-fold, 8×150 cm) using the model of external massive arterial bleeding in sheep according to the variant of marginal femoral artery injury. Some of the tests were carried out after 3 years of storage of the preparations (3 samples) and under ambient conditions minus45°C (2 tests). It was found that with external massive arterial bleeding, the use of powder and bandage in the z-fold ensured survival of the animals in 100% of cases, primary and final hemostasis was achieved in 50 and 100% of cases, respectively. Storage for 3 years, as well as use of the drug at low ambient temperature does not reduce its effectiveness. The use of local haemostatic agents «Gemohit» and «Hemohit-bandage» is not accompanied by side effects (local hyperthermal reaction, distal or proximal embolism of blood vessels). Local haemostatic funds «Gemohit» and «Gemohit-bint» showed high efficiency in the experimental model of massive external arterial bleeding. Using the local hemostatic agent «Gemohit» in the form of a bandage is more promising in terms of convenience and effectiveness than the use of powder.

Network meta-analysis of topical haemostatic agents in thyroid surgery.

The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy. A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random-effects model was used for network meta-analysis with minimally informative prior distributions. Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds ratio (OR) 1·53, 95 per cent credibility interval 0·21 to 10·77); PHA versus control (OR 2·74, 0·41 to 16·62) and AHA versus PHA (OR 1·77, 0·12 to 25·06). No difference was observed in the time required for drain removal, duration of hospital stay, and the rate of postoperative hypocalcaemia or recurrent nerve palsy. AHA led to a significantly lower total postoperative blood loss and reduced operating time in comparison with both the control and PHA groups. The general use of local haemostatic agents has not been shown to reduce the rate of clinically relevant bleeding.

Role of hemostatic powders in the management of lower gastrointestinal bleeding: A review.

Despite the recent advances in endoscopic hemostatic techniques, the management of lower gastrointestinal bleeding could be sometimes challenging. Hemostatic powders such as Hemospray, EndoClot, and Ankaferd Blood Stopper have found their way into digestive endoscopy and are licenced in many countries especially for use in upper gastrointestinal bleeding. We reviewed the literature on the use of these hemostatic powders in different situations in lower gastrointestinal bleeding and looked at the success rate and rebleeding rate. Most of the data are derived from case reports, retrospective and prospective case series with absence of any randomized controlled trials. Hemostatic powders were used as primary or salvage therapy to control bleeding from polypectomy site, colonic tumors, diverticula, arteriovenous malformations, radiation proctitis, ischemic colitis, and surgical intestinal anastomosis. The rate of immediate control of bleeding is in the range of 88-100% with a recurrence rate of 3-13% except for radiation proctitis bleeding where rebleeding rate can be as high as 77%. Although there are many advantages for the use of local hemostatic agents in lower gastrointestinal bleeding, future randomized controlled trials comparing them with conventional methods are needed.

Blood-loss Management in Spine Surgery.

Substantial blood loss during spine surgery can result in increased patient morbidity and mortality. Proper preoperative planning and communication with the patient, anesthesia team, and operating room staff can lessen perioperative blood loss. Advances in intraoperative antifibrinolytic agents and modified anesthesia techniques have shown promising results in safely reducing blood loss. The surgeon's attention to intraoperative hemostasis and the concurrent use of local hemostatic agents also can lessen intraoperative bleeding. Conversely, the use of intraoperative blood salvage has come into question, both for its potential inability to reduce the need for allogeneic transfusions as well as its cost-effectiveness. Allogeneic blood transfusion is associated with elevated risks, including surgical site infection. Thus, desirable transfusion thresholds should remain restrictive.

The Use of a Chitosan-Derived Hemostatic Agent for Postextraction Bleeding Control in Patients on Antiplatelet Treatment

The current approach for tooth extraction in patients receiving antiplatelet treatment requires the use of local hemostatic agents without previous thromboembolic treatment interruption. The aim of the present study was to evaluate the effectiveness of an extra-alveolar hemostatic agent, the HemCon Dental Dressing (HDD), in controlling postsurgical bleeding. Routine, atraumatic tooth extractions were performed in a single session under local anesthesia without a vasoconstrictor and without interruption of antiplatelet therapy. All patients underwent extraction of 2 teeth in the same session, with each in a different dental hemi-arch, and the hemostatic method to be used was randomly chosen: in the test site, the HDD was applied, whereas in the control site, a common hemostatic sponge (CollaPlug, Zimmer Dental) was applied and stabilized in situ with a suture. For each surgery, 2 different times were measured: the time required for hemostatic agent application and the time required for hemostasis achievement. Postoperative pain and healing quality also were evaluated. Twenty outpatients were enrolled. The mean application time was considerably shorter in the test group than in the control group; the mean bleeding time in the control group was considerably shorter than in the test group; pain values were lower in the test group than in the control group, especially at suture removal; and postextraction socket healing was better in the test group than in the control group. HDD seems to be a valid and safe alternative in treating postextraction sockets in outpatients under single-drug antiplatelet treatment in the absence of surgical wound lacerations.

No increased bleeding risk for oral surgery in patients with severe congenital bleeding disorders due to intense perioperative management.

In order to evaluate complication rates of dentoalveolar surgery in patients with congenital bleeding disorders, a retrospective case-control study was performed. A collective of patients with congenital bleeding disorders (n = 69), who received common oral surgery procedures in combination with intense perioperative monitoring and coagulation factor substitution at the University Hospital of Bonn between 1992 and 2011, was matched with patients without bleeding disorders by age, sex, and type of surgery. In addition to the rates of perioperative bleeding and other complications, the duration of surgery and the use of local hemostatic agents were compared between both cohorts. There were no significant differences between the two groups regarding the rate of postoperative bleeding (2.9 vs. 1.4%, patients with congenital bleeding disorders vs controls) and the rate of other complications (7.2 vs. 21.7%). Furthermore, no significant difference in operation time (54 min in patients with congenital bleeding disorders vs 45 min in controls) was observed. However, there was a significant difference (p < 0.001) regarding the use of local hemostatic measures, which were applied in all patients with hereditary bleeding disorders but in only one of the controls. All patients with bleeding disorders were inpatients, while all controls were treated in an outpatient setting. If adequate measures are taken, the complication rate following oral surgery in patients with hereditary bleeding disorders can be reduced to that of patients without bleeding disorders. However, these results are reached at significant costs due to coagulation factor replacement and inpatient treatment.

Implant surgery and oral anticoagulant therapy: case report

This work aims to assess the risks both thromboembolic that bleeding of a management protocol "non-conservative" in patients on oral anticoagulant therapy (OAT) to be undergoing implant surgery. We decided to take a surgical "non-conservative" protocol, to insert four implants in the aesthetic zone, without using flapless surgery and the surgical template. In accordance with the hematologist, the value of INR is lowered and warfarin was replaced with heparin low molecular weight, to have a better coagulation's control. The modern guidelines impose a protocol of conservative management in patients with OAT, with minimally invasive surgery, flapless, and use of surgical template to reduce the risk of uncontrolled bleeding. This, thanks to the team-work between dentist and hematologist, thanks to careful adjustment of INR and the use of local haemostatic agents, were not encountered any problems with bleeding or intra or postoperative. Surgical treatment of patients with OAT is a real problem for the oral surgeon, to treat every time in association with the hematologist. Applying this type of surgical procedure, different from today's guidelines, in our experience there were no post-operative complications (bleeding or bleeding); osseointegration has not been compromised and the prosthetic rehabilitation was completed successfully.

National prospective study on the use of local haemostatic agents during partial nephrectomy

To assess the use of local haemostatic agents (HAs) in a prospective multicentre large series of partial nephrectomies (PNs). Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy (NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010. In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed. The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm. An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024). In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%). One or more additional haemostatic action(s) was needed in 12.3% of the cases. When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size (P = 0.542), collecting system drainage (P = 0.538), hospital stay (P = 0.508), operation time (P = 0.169), blood loss (P = 0.387) or transfusion rate (P = 0.713). HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated.

Local Delivery of the Hemostatic Agent Tranexamic Acid in Chronically Anticoagulated Patients

In oral surgery, the management of patients on anticoagulant therapy is still challenging because of the risks of uncontrolled bleeding and, if the therapy is discontinued, the possibility of undesired thromboembolic complications. The use of local hemostatic agents may be a viable alternative to overcome these issues. Along these lines, the aim of this work was to evaluate the use of newly developed swelling matrices loaded with tranexanic acid in preventing postextractive bleeding in patients with no modification of oral anticoagulant therapy. The matrices are made up of cellulose and are able to fit the tridimensional postextractive alveolar cavity, thus assuring also a mechanical contribution to homeostasis. The potential of this new therapeutic approach in reducing hospitalization, removing the risk of infections, and lowering the number of hemorrhagic complications was demonstrated.

Frequency of Bleeding Following Invasive Dental Procedures in Patients on Low-Molecular-Weight Heparin Therapy

The purpose of this study was to determine the frequency of bleeding complications after invasive dental procedures in patients on low-molecular-weight heparin (LMWH) therapy. A chart review of patients who underwent invasive dental procedures while on LMWH therapy was conducted. The following information was obtained: demographics, medical history, social history, medications, relevant laboratory values, postoperative bleeding events, and use of local hemostatic agents and blood products. Forty-one patients (21 men) were identified with 42 dental appointments. The mean age was 48 years (range, 16 to 78 years). Thirty-seven patients (90%) were on LMWH therapy for deep venous thrombosis prophylaxis. Thirty-one patients (76%) were on concomitant medications that may potentiate bleeding. Multiple dental extractions (range, 2 to 14 teeth) were performed during 19 dental appointments. Twenty-one appointments were for single-tooth extraction and 2 were for soft tissue biopsies. Three patients (7%) had postextraction bleeding events. All 3 patients were on LMWH (enoxaparin) and warfarin therapy concurrently. One patient had persistent bleeding after extraction of 4 teeth (international normalized ratio, 1.6), which was successfully controlled with topical thrombin, administration of vitamin K and fresh frozen plasma, and discontinuation of enoxaparin and warfarin. Postoperative bleeding in the other 2 patients was managed successfully with local hemostatic measures and home care instructions. Our study suggests that, although postoperative bleeding in patients on LMWH therapy alone is rare to nonexistent, patients on warfarin and LMWH may be at increased risk of bleeding after invasive dental procedures.

A critically severe gingival bleeding following non‐surgical periodontal treatment in patients medicated with anti‐platelet

Only a few dental procedures have been reported to cause life-threatening bleeding. All of these cases followed surgical intervention. In this paper, we report a case of severe bleeding following non-surgical periodontal procedures in a patient treated with a dual anti-platelet regimen post-coronary stent insertion. Her medical history included ischaemic heart disease, hypertension and diabetes mellitus. Haemostasis was achieved at the conclusion of the non-surgical periodontal treatment. However, several hours later, the patient arrived at the emergency room and was diagnosed with hypovolemic shock. This case should raise the clinician's awareness of bleeding complications in non-surgical procedures as well as the risk for bleeding when a dual anti-platelet regimen is administered. The importance of patient monitoring and the use of local haemostatic agents is demonstrated in these cases.

Controlling Hemorrhage in Exodontia and Oral Surgery

Every patient should be evaluated preoperatively, in order to eliminate the possibility of an abnormal bleeding condition. Hemorrhagic disorders can be diagnosed by a thorough history supplemented with laboratory tests and a physical examination, when indicated. Surgery must be delayed until discrepancies in the coagulation mechanism or vascular defects have been corrected. Transfusions of fresh, whole blood may be needed; especially in cases of blood dyscrasias. This method of treatment will prevent serious complications. Surgical blood loss usually is underestimated in normal patients. Excessive primary bleeding can be prevented by employing sound surgical techniques. The majority of postoperative hemorrhages result from inadequate débridement of the wound, ineffective hemostasis, or failure on the part of the patient to follow postoperative instructions. The use of local hemostatic agents is helpful in arresting hemorrhage. Gelfoam and Topical Thrombin solution are recommended because of their effectiveness and their compatibility with normal healing. Systemic agents have limitations; however, if the proper agent is selected for a particular situation, it can be of value as an adjunct to other measures in establishing hemostasis.