This prospective, randomized, and experimental study was conducted on 20 female swine (Large White) in the Surgical Research Unit of the Hospital Central de la Defensa “Gómez Ulla” (Madrid, Spain). The purpose of the current study was to compare this novel MAP powder hemostatic agent with a well-known gelatin–thrombin flowable product, as a single hemostatic treatment, without any other surgical technique, in the same severe experimental liver hemorrhage model. In previous studies, we investigated the ease of use and strength of a novel modified absorbable polymer (MAP) powder (PerClot) compared with a surgical technique 13. Their efficacy depends on the patient’s own fibrin production to achieve hemostasis, so they are only appropriate for patients who have an intact coagulation system 9, 10, 11, 12. They activate and aggregate platelets and form a matrix at the site of bleeding, allowing clotting to occur 9. Others, such as porcine gelatin 10, oxidized cellulose 11, and plant-derived polysaccharide spheres 12 are known as passive hemostatic agents. These agents can be effectively used in patients with spontaneous or drug-induced coagulation disorders and are effective for a wide range of bleeding rates (including pulsatile arterial bleeding) 5, 9. Some active agents, including fibrinogen and thrombin, actively participate at the end of the coagulation cascade to form fibrin clots 7, 8, 9. Among these, topical hemostatic agents have been used to improve surgical hemostasis 1, 6.Ĭurrently, various hemostatic agents are available as adjunctive measures to control surgical bleeding. One of the most widely used classifications for hemostatic products is based on whether the product provides a physical structure around which platelets can aggregate to form a clot (passive) or whether the product delivers its mechanism of action on the clotting cascade in a biologically active manner (active) 5. Different strategies have been used to reduce surgical bleeding, specifically, hemostatic products have been used and classified in different ways based on their mechanism of action. Therefore, reducing surgical bleeding may positively impact clinical and economic aspects 1, 4. Surgical bleeding of the liver can lead to a significant increase in morbidity and mortality rates, longer surgical procedures, longer hospital stays, and increased costs 1, 2, 3. Both the flowable and the MAP hemostatic agents were able to effectively control surgical bleeding in a novel severe liver injury model, however, the flowable gelatin–thrombin agent provided quicker and better bleed control.īleeding is a prevalent complication of liver surgery that negatively affects clinical outcomes. Kaplan–Meier survival analysis indicated similar rates of death between study groups (Logrank test p = 0.3395). The mean arterial pressure gradually recovered in the flowable group by 24 h, whereas in the MAP group, the mean arterial pressure was consistently stayed below baseline values. The rate of blood loss was significantly lower in the flowable group compared with the MAP group as measured from time of injury to minutes 3, 9, 12, and 120 (except for 6 min). The main outcome measure was total blood loss volume. We used a novel severe liver injury model that caused exsanguinating hemorrhage. Twenty swine were prospectively randomized to receive either active Flowable (Floseal) or passive MAP powder (PerClot) hemostatic agents. We have hypothesized that a single hemostatic agent might be as effective as a unique hemostatic surgical technique. ![]() Both surgical technique and hemostatic agents can be used together as a means of controlling bleeding. This study compares the effectiveness of two different types of hemostatic agents, one is an active flowable hemostat and the other is a passive hemostat made of modified absorbable polymers. ![]() There are many surgical techniques (packing, Pringle maneuver, etc.) and hemostatic agents to manage hepatic bleeding in trauma surgery.
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