Effectiveness evaluation of hemostatic materials in acute exposure in vivo

Aim: comparative assessment of the effectiveness of hemostatic materials in an acute experiment in vivo.

Materials and methods. We studied samples of hemostatic materials TachoComb (No. 1), Gelita-Spon Standard (No. 2), Surgicel Fibrillar (No. 3), samples of hemostatic sponges developed jointly with LLC ”Lintex“ (St. Petersburg, Russia) based on sodium carboxymethyl cellulose ( Na-CMC): Na-CMC + Tranexamic acid, pressed (No. 4), Na-CMC + Tranexamic acid, uncompressed (No. 5), Na-CMC pressed (No. 6), Na-CMC uncompressed (No. 7). Rats under general anaesthesia were given a middle laparotomy, and the partial liver resection of the left liver lobe was simulated. The bleeding was stopped by application of test materials. Blood loss volume (blood volume absorbed by one sample), bleeding time were evaluated. We applied nonparametric criterion of Mann-Whitney (p ≤ 0.05) to determination of reliability of differences.

Results. The lowest values of the index ”Bleeding time“ are observed in experimental groups No. 4-No. 7. Among the samples of these groups there are the following statistically significant differences: the values of the samples of group No. 4 are 1.5 times higher than that of sample No. 5; 2.68 times – group No. 6; 2.41 times – groups No. 7. The values of samples of group No. 7 are 1.74 times less than samples of group No. 5 and 4 seconds more than in group No. 6. When comparing blood loss volume in investigated groups, fewer statistically significant differences are observed. But the values of the samples of group No. 2 significantly exceed the values of all experimental groups.

Conclusion. The use of a local hemostatic agent based on Na-CMC (with and without the addition of tranexamic acid) in stopping bleeding after the partial liver resection in laboratory animals (rats) is no less than clinically introduced applicational hemostatic agents such as TachoComb, Gelita-Spon Standard and Surgicel Fibrillar.

1. Bazaev А.V., Аlejnikov А.V., Korolev S.K., Kokobelyan А.R., Rodin А.G. The damages of liver and spleen of the injured with the combined automobile trauma. Journal MediAl. 2014; 1 (11): 17–19. (In Russian)

2. Babak A., Samad S.V., Seyedpouya P., Sarvin A. Blunt abdominal trauma and organ damage and its prognosis. J. Anal. Res. Clin. Med. 2016; 4 (4): 228–232. https://doi.org/10.15171/jarcm.2016.038

3. Balaphas A., Meyer J., Harbarth S., Amzalag G., Buhler L.H., Morel P. Patient management after splenectomy in 2015: state of the art and recommendations. Rev. Med. Suisse. 2015; 11 (479): 1345–1350.

4. Vecchio R., Catalano R., Basile F., Spataro C., Caputo M., Intagliata E. Topical hemostasis in laparoscopic surgery. G. Chir. 2016; 37 (6): 266–270. https://doi.org/10.0.43.130/gchir/2016.37.6.266

5. Samokhvalov I.M., Reva V.A., Denisov A.V., Telitskii S.Yu., Adamenko V.N., Churkin A.A., Yudin A.B., Yablokov I.P. Assessing effectiveness of topical hemostatic chitosan-based agents in experiments. Voenno-medicinskij zhurnal = The Military Medical Journal. 2017; 2 (338): 18–24. (In Russian)

6. Franco I.V., Bashankaev B.N., Yunusov B.Т., Аliev V.А., Shavgulidze К.B., Loria I.Zh., Grigorieva О.А. Experience of application of TachoSil in laparoscopic surgeries. Endoscopic surgery. 2017; 23 (6): 19–24. https://doi.org/10.17116/ endoskop201723619-24 (In Russian)

7. Güven H.E. Topical hemostatics for bleeding control in prehospital setting: then and now. Ulus Travma Acil Cerrahi Derg. 2017; 5 (23): 357–361. https://doi.org/10.5505/tjtes.2017.47279.

8. Mita K., Ito H., Murabayashi R., Asakawa H., Nabetani M., Kamasako A., Koizumi K., Hayashi T. Use of a fibrinogen/ thrombin-based collagen fleece (Tachocomb, Tachosil) with a stapled closure to prevent pancreatic fistula formation following distal pancreatectomy. Surg. Innov. 2015; 22 (6): 601–605. https://doi.org/10.1177/15533506155806499.

9. Davydenko V.V., Vlasov T.D., Dobroskok I.N., Brazhnikova Е.N., Zabivalova N.M. Competitive efficiency of local application hemostatic agents in experimental parenchymatous and arterial bleeding control. Journal of Experimental and Clinical Surgery. 2015; 8 (2): 186–194. https://doi.org/10.18499/2070-478X-2015-8-2-186-194 (In Russian)

10. Wang L. Research progress and application status of topical absorbable hemostatic. Postgrad. Med. J. 2018; 1 (31): 109–112. https://doi.org/10.16571/j.cnki.1008-8199.2018.01.023.

11. Timoshenkova A.V., Kuzmin M.V., Katanov E.S. Assessment of biliostatic properties of modern topic hemostatic means used in hepatic surgery. Perm Medical Journal. 2018; 1 (35): 102–107. https://doi.org/10.17816/pmj351102%107 (In Russian)

12. Fonouni H., Kashfi A., Majlesara A., Stahlheber O., Konstantinidis L., Gharabaghi N., Kraus T.W., Mehrabi А., Oweira H. Hemostatic efficiency of modern topical sealants: comparative evaluation after liver resection and splenic laceration in a swine model. J. Biomed. Mater. Res. Part B: Appl. Biomater. 2018; 3 (106): 307–1316. https://doi.org/10.1002/jbm.b.33937.

13. Lipatov V.A., Lazarenko S.V., Severinov D.A. A study of spleen tissue reaction using new samples of polymeric hemostatic materials. Polytrauma. 2019; 4: 83–94. (In Russian)

14. Lipatov V.A., Lazarenko S.V., Sotnikov K.A., Severinov D.A., Ershov M.P. To the issue of methodology of comparative study of the degree of hemostatic activity of topical hemostatic agents. Novosti khirurgii. 2018; 1 (26): 81–95. https://doi.org/10.18484/2305-0047.2018.1.81 (In Russian)

15. Lipatov V.A., Severinov D.A., Kryukov A.A., Saakyan A.R. Ethical and legal aspects of in vivo experimental biomedical research of the conduct. Part II. Pavlov Russian Medical Biological Herald. 2019; 2 (27): 245–257. https://doi.org/10.23888/ PAVLOVJ2019272245-257 (In Russian)