Use of local pro-coagulant haemostatic agents for intra-cavity control of haemorrhage after trauma

 

Published on MedED:  8 October 2020
Type of article: Clinical Article Summary

Compiler: Linda Ravenhill
Sources: Navarro A., Brooks A. Eur J Trauma Emerg Surg (2015) 41: 493-500 DOI 10.1007/s00068-014-0441-4 Epub 2014 Aug 26.
 
Uncontrolled haemorrhage as a result of trauma accounts for approximately 25–40 % of trauma-related mortality. In certain cases, simple packing may not always be sufficient to control bleeding, especially in coagulopathic patients.

As a result, there is a surgical interest in products that promote local haemostasis within body cavities as adjuncts to surgical control. A wide range of haemostatic agents is available including several mucoadhesive products based on gelatin, cellulose, chitin, collagen or semi-synthetic material. However, in coagulopathic patients such as those often encountered at trauma laparotomy, these agents are generally less effective since they rely on the native clotting cascade.

Pro-coagulant products that contain thrombin and/or fibrinogen have the ability to act relatively independently of the clotting cascade and so are more effective in the presence of coagulopathy. They include:

Liquid Fibrin Sealants: The final common pathway of the human coagulation cascade involves activation and conversion of prothrombin to thrombin, which in turn converts fibrinogen to fibrin. Liquid Fibrin Sealants aim to independently provide these biological factors without reliance on intrinsic systems. They have limitations including that they can easily be diluted and washed off the surface by brisk high-volume bleeding and, if pressure needs to be applied then the packs used to do this can adhere to the fibrin glue and cause lifting off of the sealant when removed.

Fibrin Sealant Patches: These combine thrombin and fibrinogen on some type of patch or sponge, Existing evidence suggests that patch products enable the delivery of procoagulants to defined areas with less chance of dilution and/or displacement by blood flow, but they require a pressure buttress for a suitable amount of time to achieve good results after trauma.

Gelatin-thrombin matrix products consists of a matrix of cross-linked bovine-derived gelatin granules with human thrombin. The gelatin granules swell on contact with blood or body fluids and blood flow is reduced through a tamponade effect, with the thrombin acting to increase haemostatic efficacy. They have been shown to be effective in a range of indications, including cardiac and vascular surgery, traumatic liver and spleen rupture,  severe haemorrhagic shock and coagulopathy.

Summary reproduced with kind permission from MedSpec Publishing.
   
Contributor: Linda Ravenhill
Linda Ravenhill is a medical professional with an MA in Journalism. She has worked in the medical, technology and digital development spaces for over 25 years, & has a particular interest in the impact of technology on the delivery of healthcare in the Sub-Saharan Africa region.

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