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Comparison of hemostatic agents used in vascular surgery.

ABSTRACT: Over the past 15 years, a wide range of agents have been developed for use in surgical procedures to achieve hemostasis. These agents can be divided into three broad categories: hemostats, sealants and adhesives. They vary widely related to their mechanism of action, composition, ease of application, adherence to wet or dry tissue, immunogenicity and cost.This article focuses on the agents used in vascular surgery to achieve hemostasis; agents involved in clinical trials are also covered.When surgeons achieve rapid hemostasis, potential benefits include better visualization of the surgical area, shorter operative times, decreased requirement for transfusions, better management of an anticoagulated patient, decreased wound healing time and overall improvement in patient recovery time. The need for safe and efficacious hemostatic agents that can provide a range of benefits is clearly a significant surgical issue.

SUBMITTER: Vyas KS

PROVIDER: S-EPMC4390172 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Comparison of hemostatic agents used in vascular surgery.

Vyas Krishna S KS Saha Sibu P SP

Expert opinion on biological therapy 20131022 12

<h4>Introduction</h4>Over the past 15 years, a wide range of agents have been developed for use in surgical procedures to achieve hemostasis. These agents can be divided into three broad categories: hemostats, sealants and adhesives. They vary widely related to their mechanism of action, composition, ease of application, adherence to wet or dry tissue, immunogenicity and cost.<h4>Areas covered</h4>This article focuses on the agents used in vascular surgery to achieve hemostasis; agents involved ...[more]

PMID: 24144261

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Project description:BackgroundIn dogs, the effects of immunosuppressive medications on hemostasis are not well known.Hypothesis/objectivesThe objective was to determine the effects of immunosuppressive medications on primary and secondary hemostasis. Our hypothesis was that cyclosporine and prednisone would increase markers of hypercoagulability and thromboxane synthesis, while azathioprine, mycophenolate mofetil, and leflunomide would have minimal effects on hemostasis.AnimalsEight healthy dogs.MethodsA randomized, cross-over study used aggregometry, the PFA-100 platelet function analyzer, viscoelastometry, platelet count, and prothrombin and activated partial thromboplastin times to evaluate hemostasis during the administration of prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and leflunomide for 1 week each at standard oral doses. Urine 11-dehydro-thromboxane-B2 (11-dTXB2 ) and 6-keto-prostaglandin-F1? (6-keto-PGF1? ) concentrations, normalized to urine creatinine concentration, were measured.ResultsThe aggregometry amplitude decreased from 51?±?21 to 27?±?14 (P?=?.002) during leflunomide treatment (ADP activation), but there were no differences in amplitude (P?=?.240) for any medications when platelets were activated with collagen. For all medications, there were no significant differences in viscoelastometry indices (ACT, P?=?.666; ClotRate, P?=?.340; and platelet function, P?=?.411) and platelet count (P?=?.552). Compared with pretreatment values, urinary 11-dTXB2 -to-creatinine ratio increased (P?=?.001) after drug administration (from 3.7?±?0.6 to 5.6?±?1.1). Cyclosporine was associated with an increase (P?<?.001) in the 6-keto-PGF1? -to-creatinine ratio (from 10.3?±?4.6 to 22.1?±?5.3).Conclusions and clinical importanceMost immunosuppressive drugs do not enhance platelet function or coagulation in healthy dogs, suggesting that these medications might not predispose hypercoagulable dogs to thromboembolism. The results of our study need to be correlated with the clinical outcomes of hypercoagulable dogs.

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Comparison of hemostatic agents used in vascular surgery.

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Comparison of hemostatic agents used in vascular surgery.

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