A contemporary systematic review of the complications associated with SURGICEL

Efficacy of topical hemostatic agents in neurosurgery: An experimental study in a rat model

Background

Few studies have compared different topical hemostatic agents in live models or brain tissue, and their doses are not standardized. Little is known about the combined use of these different elements in terms of efficacy and safety, especially in neurosurgery. The objective of this study was to evaluate the efficacy of different topic hemostatic agents used in daily neurosurgical practice in an experimental animal model study.

Methods

A group of 42 Wistar rats was used. A stereotaxic frame was fixed, and coordinates were determined to locate the bregma. A 3 mm hole was drilled with a bone-profile burr on each side of the midline. A stylet was inserted into the brain to create the defect and induce bleeding. The rats were randomly divided into seven groups, with each group assigned a hemostatic agent. Hemostasis time and control time on the opposite side were measured.

Results

Hemostasis was achieved after an average of 1 82 s in the group treated with Beriplast, making it the hemostatic agent that stopped the bleeding the fastest. The control time was an average of 40, 14 s. Compared with the negative control, all the agents resulted in significantly better hemostasis (P < 0.05).

Conclusion

A reduction in postoperative bleeding positively impacts annual morbidity and mortality rates, hospitalization time, and hospital bed turnover. Understanding the efficacy and safety of different hemostatic agents will enable surgeons to optimize intraoperative hemostasis, thereby achieving better postoperative outcomes and increased patient safety.

Use of Ultra-Hydrophilic Absorbable Polysaccharide for Bleeding Control in Cardiothoracic Surgical Procedures

Background and Objectives: Operative blood loss is strongly correlated with morbidity and mortality in surgery. Various hemostatic agents are used to reduce bleeding in cardiothoracic procedures. We report our experience with a plant-based microporous polysaccharide hemostatic powder (Starsil® Hemostat, Hemostat Medical GmbH, Velen, Germany). Materials and Methods: Data were collected retrospectively from 65 patients who underwent cardiac surgery at our institution from January 2012 to January 2015 with (n = 42) or without (n = 23; control group) the use of the hemostat powder. Primary endpoints were safety (e.g., laboratory parameters, adverse events, and infection parameters) and time to hemostasis when the hemostat powder was used. Other endpoints included operation time, hospitalization, quantity of the hemostat powder applied, and length of stay in the intensive care unit. Results: The 65 patients (49 male:16 female) analyzed in the study underwent 65 cardiothoracic procedures, including off-pump coronary artery bypass grafts (n = 25), on-pump coronary artery bypass grafts (n = 6), valve procedures (n = 6), valve procedures in combination with bypass grafts (n = 7), and others (n = 21). The application of the hemostat powder did not increase adverse events. The laboratory parameters did not exceed the expected range after heart surgery in both groups. The hemostat powder had no significant impact on the laboratory parameters compared to the control group. Blood control was sufficient and was rated by surgeons from good to very good on a visual analog scale (VAS) from 1 (very bad) to 10 (very good) [VAS = 8.3 ± 1.2]. Intraoperative hemostasis was possible in nearly all patients. The hemostat powder led to satisfactory bleeding control within 2 min in 88% of cases. Five patients needed a second 5 g unit of the hemostat powder. Conclusions: The observed parameters between groups did not differ significantly. Therefore, the use of Starsil® Hemostat in cardiothoracic surgery is safe and effective bleeding control was achieved.

Gluing blood into adhesive gel by oppositely charged polysaccharide dry powder inspired by fibrin fibers coagulation mediator

Hemostatic powders that adapt to irregularly shaped wounds, allowing for easy application and stable storage, have gained popularity for first-aid hemorrhage control. However, traditional powders often provide weak thrombus support and exhibit limited tissue adhesion, making them susceptible to dislodgment by the bloodstream. Inspired by fibrin fibers coagulation mediator, we have developed a bi-component hemostatic powder composed of positively charged quaternized chitosan (QCS) and negatively charged catechol-modified alginate (Cat-SA). Upon application to the wound, the bi-component powders (QCS/Cat-SA) rapidly absorb plasma and dissolve into chains. These chains interact with each other to form a network, which can effectively bind and entraps clustered red blood cells and platelets, ultimately leading to the creation of a durable and robust thrombus. Significantly, these interconnected polymers adhere to the injury site, offering protection against thrombus disruption caused by the bloodstream. Benefiting from these synthetic properties, QCS/Cat-SA demonstrates superior hemostatic performance compared to commercial hemostatic powders like Celox™ in both arterial injuries and non-compressible liver puncture wounds. Importantly, QCS/Cat-SA exhibits excellent antibacterial activity, cytocompatibility, and hemocompatibility. These advantages of QCS/Cat-SA, including strong blood clotting, wet tissue adherence, antibacterial activity, biosafety, ease of use, and stable storage, make it a promising hemostatic agent for emergency situations.