Improved bleeding scores using Gelfoam® Powder with incremental concentrations of bovine thrombin in a swine liver lesion model

Abstract

Topical hemostatic agents are used intra-operatively to prevent uncontrolled bleeding. Gelfoam Ò Powder contains a hemostatic agent prepared from purified pork skin gelatin, the efficacy of which is increased when combined with thrombin. However, the effect of increasing concentrations of thrombin on resultant hemostasis is not known. This study sought to evaluate the ability of various concentrations of thrombin in combination with Gelfoam Powder to control bleeding using a swine liver lesion model. Ten pigs underwent a midline laparotomy. Circular lesions were created in the left medial, right medial, and left lateral lobes; six lesions per lobe. Gelfoam Powder was hydrated with Thrombin-JMI Ò diluted to 250, 375, and 770 IU/mL. Each concentration was applied to two lesion sites per lobe. Bleeding scores were measured at 3, 6, 9, and 12 min using a 6-point system; comparison of bleeding scores was performed using ANOVA with the post hoc Tukey test. The bleeding scores with thrombin concentrations at 770 IU/mL were significantly lower than at 250 and 375 IU/mL at all four time points. The percentage of biopsies with a clinically acceptable bleeding score rose from 37.9, 46.6, and 71.2 % at 3 min to 55.2, 69.0, and 88.1 % at 12 min in the 250, 375, and 770 IU/mL thrombin groups, respectively. The study showed that the hemostatic response to thrombin was dose-related: using higher concentrations of thrombin with Gelfoam Powder yielded improved hemostasis, as determined by lower bleeding scores.

Hemostatic Comparison of a Polysaccharide Powder and a Gelatin Powder

“…4 Among the various classes of hemostatic agents, powdered hemostats have been widely adopted for their easeof-use; however, their efficacy has been limited to low-level bleeds. [5][6][7][8][9][10][11][12][13][14] More recently, the benefit of using powdered hemostats intraoperatively to treat low-level bleeds has been demonstrated clinically. [15][16][17][18][19][20] The two predominant materials within this class of hemostatic agents are a polysaccharide-based powder and a fibrinogen-thrombin based powder.…”

Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization

“…22 The authors recommend using the flowable hemostatic agent in combination with thrombin solution. The hemostatic effects of different concentrations of thrombin solution (25,03,75,770 IU/ml) have been compared and its hemostatic effects have been shown to be dose-dependent 4 ; i.e., to improve with increasing concentration. However, the concentration of thrombin used in this study was relatively low, and further studies are needed to determine the optimal concentration of thrombin to mix with the flowable hemostatic agent.…”

“…Uncontrolled intraoperative bleeding may lead to complications and adverse intraoperative or perioperative outcomes, including increased bleeding volume and time requiring blood transfusions or blood-related products, hematoma formation, prolonged postoperative hospitalization and increased hospitalization costs, increased risk of infection and shock, and increased mortality. 1–4 Adequate hemostasis is thus a major consideration for surgeons aiming to avoid these negative consequences. Hemostasis is generally achieved by suture ligation of larger vessels and manual compression, and using an ultrasound knife and bipolar electrocautery for small vessels.…”

Substitution of Percutaneous Ethanol Injection with a Low Molecular Weight Peptide Gel Mimicking Chemoembolization for Cancer Therapy

“… 14 , 15 Embolization particles or gel foam were then used to reduce arterial inflow, induce tissue ischemia, and decrease the washout of the chemotherapeutic agents into the systemic circulation in order to prolong the contact time between cancer cells and drugs. 16 , 17 Embolizing particles in the hepatic artery occluded nutrition supply to tumors.…”