Hemostatic Management: Topical applications

Summary This study reporting on the numerous biochemical and physiologic functional changes that occur during red blood cell (RBC) storage may provide some explanation for the multiple studies demonstrating an association between RBC transfusion and adverse patient outcomes. Bennett-Guerrero and colleagues collected blood from 15 healthy volunteers. The samples were processed, leukofiltered and stored according to blood-banking industry standards.

Summary Blood transfusions have inherent risks and one of the associated factors is the length of storage, during which RBCs undergo structural and functional changes. Koch and colleagues determined whether complications and mortality increase in patients undergoing cardiac surgery who are given transfusions of RBCs that have been stored >2 weeks. Adult patients undergoing coronary artery bypass grafting (CABG), heart valve, or both procedures received exclusively RBCs stored ≤14 days or >14 days (considered as “newer” and “older” blood, respectively).

Summary This prospective observational study involving 165 patients evaluated the combined use of platelet gel and fibrin sealant as a blood management strategy in patients undergoing unilateral total knee replacement surgery. A consecutive series of 80 patients operated on without platelet gel (PG) and fibrin sealant (FS) served as the control group. A consecutive series of 85 patients operated on thereafter in whom PG and FS were applied made up the study group.

Summary This multicenter randomized double-blind comparative study found recombinant human thrombin (rhThrombin) to be of similar efficacy and safety profile as bovine thrombin (bThrombin) for surgical hemostasis while being significantly less immunogenic. Bovine derived topical thrombin is reported to be used as a topical hemostatic agent in over 1 million patients each year in the US. However, the authors refer to estimates of 20% or more of patients developing antibodies to the product. Accordingly, an alternative recombinant product was developed.

Abstract

BACKGROUND:

Topical application of tranexamic acid to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. The objective of the present trial was to assess the efficacy and safety of the topical application of tranexamic acid on postoperative blood loss in patients undergoing primary unilateral total knee arthroplasty with cement.

METHODS:

Abstract

OBJECTIVE:

To evaluate the literature describing topical use of tranexamic acid or aminocaproic acid for prevention of postoperative bleeding after major surgical procedures.

DATA SOURCES:

Literature was retrieved through MEDLINE (1946-September 2011) and International Pharmaceutical Abstracts (1970-September 2011) using the terms tranexamic acid, aminocaproic acid, antifibrinolytic, topical, and surgical. In addition, reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: