Avitene™ Microfibrillar Collagen Hemostat for Adjunctive Hemostasis in Surgical Procedures: A Systematic Literature Review

Abstract

Adequate hemostasis during surgical procedures is essential for successful patient outcomes and reduced healthcare resource utilization. Topical hemostatic agents can act as catalysts for the clotting cascade or as a scaffold to promote platelet activation or aggregation. Although an ever-increasing number of topical absorbable hemostatic agents are now available for perioperative use, health care providers are disadvantaged by the lack of comparative data on feasibility, clinical effectiveness, advantages, and limitations of each in specific surgical settings. This knowledge is important for appropriate product choice when patient characteristics, type of surgical procedure, type of bleeding, and product availability may differ widely. This manuscript provides the first comprehensive overview of Avitene™ Microfibrillar Collagen Hemostat (MCH), a bovine collagen-based absorbable hemostat that has been widely used for over four decades in the United States and abroad. MCH is indicated as an adjunct to hemostasis across a broad spectrum of surgical specialties and has been shown to achieve hemostasis with positive patient outcomes and a favorable safety profile in many applications, including hepatic, orthopedic, splenic, oral, and otolaryngologic surgery. Although published clinical data regarding the use of MCH in cardiovascular surgery is limited, evidence suggests moderate use in this specialty. The information contained in this systematic review will help health care providers understand the clinical use and effectiveness of the product to determine appropriate use in differing bleeding scenarios across multiple surgical specialties. Future studies may include comparative functional and cost analyses to explore the economic advantages of using absorbable hemostatic agents compared with each other or with conventional techniques of hemostasis, when appropriate.

A ternary biocomposite based on modified fish scale collagen and ginsenoside Rb1: preparation, properties and bioactivities

“…All MCF samples have a good hemostatic ability, with a much shorter clotting time than that of the control sample. It could be suggested that when in contact with blood, the platelets were adhered to collagen fibrin and then they were aggregated 3 . These results have a high accuracy with RSD < 2% and there were significant differences in clotting time between experimental groups ( P < 0.001).…”

“…In modern surgery, passive hemostatic agents such as microfibrillar collagen, collagen sponges, collagen membranes, oxidized regenerated cellulose, gelatin sponges and mesoporous polysaccharide spheres are topical hemostatic agents that have been commonly used owing to their convenience, fast hemostasis, immediate availability, ease of use, cost effectiveness and storage at room temperature. [1][2][3][4][5][6][7] These hemostatic agents work by interacting with a bleeding surface, absorbing fluid and promoting platelet activation and aggregation to form blood clots. 8 Among passive hemostatic agents, collagen has many applications in various forms, including microfibers, sponges, membranes, powders, sheets and pads.…”

Embolic Agents: Particles

“…11 A similar temporary embolic agent composed of microfibrillar collagen works by activating platelet aggregation and the formation of fibrin to enhance hemostasis. 12 Drug-eluting beads (DEBs) are a newer generation of microspheres that have the capability to be loaded with chemotherapeutic agents to provide localized tumor treatment. The drug-loading capacity of these particles utilizes a negatively charged ionic group to bind to positively charged chemotherapy drugs (►Fig.…”

“…11 A similar temporary embolic agent composed of microfibrillar collagen works by activating platelet aggregation and the formation of fibrin to enhance hemostasis. 12…”

A Guide to Collagen Sources, Applications and Current Advancements

“…The structural and signaling role of collagen makes it an ideal biomaterial for applications in the field of biomedical [7], cosmetics [8], nutraceuticals [9] and pharmaceuticals. In addition, natural properties like hemostatic activity [10], biodegradability [11] and cross-linking ability of collagen find a wide application in the drug delivery systems [12][13][14]. Gelatin, a biopolymer obtained by partial hydrolysis of collagen fibres has major applications in confectionery, food, pharmaceutical, medical, cosmetic products [15].…”