Objective:Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research.Materials and Methods:A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemostatics, cyanoacrylate adhesives, oxidized regenerated cellulose, and microfibrillar collagen were included. References were chosen from a broad range of surgical literature.Results:Topical hemostatic agents have historically taken advantage of a wide variety of mechanisms for hemostasis. Fibrin sealants have a rich history and large potential for further applications. Gelatin sponge hemostatics have been widely used since their introduction, but have changed little. Cyanoacrylate adhesives have a unique mechanism and opportunity for novel applications of existing products. Oxidized cellulose was original in the use of plant-based components. Microfibrillar collagen hemostats have evolved to a wide variety of formats.Conclusions:A review of the evolution of topical hemostatic agents highlights opportunities for potential novel research. Fibrin sealants may have the most opportunity for advancement, and understanding the history of these products is useful. With the drive in urology for minimally invasive surgical techniques, adaptation of topical hemostatic agents to this surgical approach would be valuable and offers an opportunity for novel contributions.

Objectives-The objective of this study was to determine whether adjunctive therapy during percutaneous coronary intervention (PCI) affects markers of systemic inflammation or platelet activation. Despite different mechanisms of action, direct-thrombin inhibition with bivalirudin during PCI provided similar protection from periprocedural and chronic ischemic complications as compared with unfractionated heparin (UFH) plus planned use of GPIIb/IIIa antagonists in the REPLACE-2 and ACUITY trials. Methods and Results-Patients undergoing nonurgent PCI of a native coronary artery were randomized to receive adjunctive therapy with bivalirudin or UFHϩeptifibatide. Interleukin (IL)-6 and C-reactive protein (CRP) transiently increased in both groups after PCI. In the UFHϩeptifibatide, but not the bivalirudin group, myeloperoxidase (MPO) levels were elevated 2.3-fold above baseline (Pϭ0.004) immediately after PCI. In an in vitro assay, heparin and to a lesser extent enoxaparin, but not bivalirudin or eptifibatide, stimulated MPO release from and binding to neutrophils and neutrophil activation. A mouse model of endoluminal femoral artery denudation was used to investigate further the importance of MPO in the context of arterial injury. Key Words: platelets Ⅲ neutrophils Ⅲ myeloperoxidase Ⅲ percutaneous coronary intervention Ⅲ adjunctive therapy A ggressive antithrombotic therapy, in particular antiplatelet therapy with glycoprotein (platelet glycoprotein [GP]) IIb/IIIa antagonists, thienopyridines, and aspirin used in conjunction with unfractionated heparin, have consistently been shown to decrease the risk of periprocedural thrombotic complications associated with percutaneous coronary interventions (PCI). 1,2 Bivalirudin, a direct thrombin inhibitor, was approved for use in PCI as an alternative to heparin before to widespread use of GPIIb/IIIa antagonists. Recently, the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 and the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trials demonstrated that bivalirudin used with GPIIb/IIIa antagonists on a provisional basis provided similar protection from periprocedural ischemic and hemorrhagic complications compared with heparin plus planned use of GPIIb/IIIa antagonists. 3,4 In the REPLACE-2 trial of low-to moderate-risk patients undergoing PCI, the primary composite end point at 30 days (incidence of death, myocardial infarction, urgent repeat revascularization, or in-hospital major bleeding) occurred in 9.2% of patients in the bivalirudin group versus 10.0% of patients in the unfractionated heparin (UFH) plus GPIIb/IIIa antagonist group. 3 At 1 year, a nonsignificant trend toward lower mortality with bivalirudin was observed (1.9% in bivalirudin group and 2.5% in heparin plus GPIIb/ IIIa antagonist group). 3 The results from the ACUITY trial also suggest that in patients with acute coronary syndromes undergoing PCI, routine use of bivalirudin is associated with similar ischemic outcomes as UFH or low-molecular weight...

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