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Haemorrhage control during surgery and following traumatic injury remains a critical, life-saving challenge. Cellulose products are already employed in commercially available haemostatic dressings. This work explores sourcing cellulose from sugarcane trash pulp to produce micro- and nanosized fibres with hydroxyl, carboxylic acid, and trimethylamine functional groups, resulting in either positive or negative surface charges. This paper assesses the influence of these fibres on multiple blood clotting parameters in both dispersed solutions and dry gauze applications. In vitro blood clotting studies demonstrated the significant haemostatic potential of cellulose fibres derived from sugarcane waste to initiate clotting. Plasma absorbance assays showed that the 0.25 mg/mL cellulose microfibre dispersion had the highest clotting performance. It was observed that no single property of surface charge, functionality, or fibre morphology exclusively controlled the clotting initiation measured. Instead, a combination of these factors affected clot formation, with negatively charged cellulose microfibres comprising hydroxyl surface groups providing the most promising result, accelerating the coagulation cascade mechanism by 67% compared to the endogenous activity. This difference in clot initiation shows the potential for the non-wood agricultural waste source of cellulose in haemostatic wound healing applications, contributing to the broader understanding of cellulose-based materials' versatility and their applications in biomedicine. [ABSTRACT FROM AUTHOR]

Introduction: Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII by binding to factor IXa and factor X to achieve haemostasis in haemophilia A. The long half-life and subcutaneous mode of administration makes emicizumab a compelling treatment option for bleeding prophylaxis. There is still limited real-world data on its use and management considerations, especially during surgical procedures. The objective of the study is to describe the real-world experience of emicizumab in a cohort of adult and paediatric haemophilia A patients in Singapore, including its use in the periprocedural setting. Method: This was an observational study conducted at the 2 main haemophilia treatment centres in Singapore. All haemophilia A patients who commenced treatment with emicizumab before 1 July 2022 were recruited. Results: A total of 18 patients with haemophilia A were included in this study. Ten (55.6%) patients had active inhibitors. The median annual bleeding rate for all patients before emicizumab use was 4.5 events (interquartile range [IQR] 2.8-8.3) compared with 0 events (IQR 0-0) after emicizumab was commenced (P=0). There were no adverse events of venous or arterial thrombosis, thrombotic microangiopathy, or death. A total of 6 procedures in 5 patients were performed during the study period with no major bleeding complications. Conclusion: Emicizumab effectively protects against bleeding in haemophilia A patients with and without inhibitors, including in children less than 12 years old. More studies are required to address clinical nuances, such as periprocedural management and the role of immune tolerance in patients with inhibitors on emicizumab. [ABSTRACT FROM AUTHOR]

Objective: PerClot® is a biocompatible, polysaccharide haemostatic system recommended for surgical procedures. It is an absorbable modified polymer that is non-pyrogenic and is derived from purified plant starch. Our goal was to evaluate the safety, efficacy and usefulness of PerClot® in head and neck surgery (H&N) in our department. Methods: All patients who received PerClot® after their neck operation over 1-year period (2019–2020) were prospectively investigated. The information collected included demographics, admission and discharge dates, type of operation, operative details, postoperative complications and their management. The data were collected and analysed using Excel. Results: A total of 57 patients (males = 26, females = 31) with mean age of 51 (range 19–83) were identified. None of the patients developed primary or secondary haemorrhage. Ten patients suffered from post-operative wound complications (18%). Wound infection was noticed in 9/57 (16%) of patients. 1/57 patients had seroma. Conclusions: PerClot® is safe, effective in reducing the postoperative bleeding and would appear to be useful in head and neck surgery with minimal adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function. Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function. Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups. Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

The aim of the present study was to analyse differences in the tissue response to the different haemostatic agents used for periapical surgery (BloodSTOP iX® (oxicellulose), Expazen® (aluminum chloride), calcium sulphate (CS), Gelatamp® (gelatin sponge) and Hemocor® (ferric sulphate). Seventy‐two bone defects were made on the calvarium of 36 Sprague‐Dawley rats. The specimens were euthanised at 3, 6 and 12 weeks. Histological analysis revealed a giant cell foreign body reaction against BloodStop iX®, Gelatamp® and Hemocor®. Leukocytes persisted at the surgical bed during the healing process longer as expected with Gelatamp® (6 weeks) and Hemocor® (12 weeks). We confirmed a generalised delay in bone formation. Calcium sulphate did not cause any foreign body reaction. CS showed excellent results with a high degree of compatibility, there was no inflammatory reaction with this agent after 12 weeks and was not associated with a significant foreign body reaction at any time during the study. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the effect of two commercially available haemostatic agents (i.e., collagen sponge and oxide cellulose) on early healing of the extraction socket. Material and Methods: In a murine model, bilateral maxillary first molars were extracted and the sockets were filled with or without haemostatic agents. Histology, histomorphometry and immunostaining assays were performed on samples harvested on postextraction day 1, 3, 7 and 14. In vitro studies were also designed to investigate the effect of agents on the dynamics of pH and viability of cells. Results: Early socket healing was delayed by both agents but with different patterns. The migration of cells was impeded by oxide cellulose on postextraction day 1 compared with the collagen and the control group. The proliferation and osteogenic differentiation of cells were delayed by both materials. Moreover, apoptosis of periodontal ligament cells was present in the haemostatic agent groups. These effects are attributed to the compression to periodontal ligament by both agents, the acidic niche caused by oxide cellulose, and the intense foreign body reaction and inflammatory response caused by the agents. Conclusions: The placement of haemostatic agents delay the early extraction socket healing via different biological mechanism. [ABSTRACT FROM AUTHOR]

Zeolite is a multifunctional material, which recently exhibited promising prospects in emerging biological and medical applications. This study reported a new bio-inorganic hybrid of zeolite-fibrin clot composite serving as haemostatic agent in haemophilia A. The zeolite-fibrin clot composite promoted haemocompatibility and helped to achieve short clotting time both in vitro (22 ± 3 s vs. >600 s) and in vivo (4.5 min vs. >60 min) compared to control in coagulation factor VIII deficiency bleeding model. Therefore, in situations of surgical operation or accidental injury, this effective and ready-to-use haemostatic agent may provide rapid haemostasis for haemophilia A patients. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function. Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intra-and post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function. Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups. Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function. [ABSTRACT FROM AUTHOR]

Introduction: Emicizumab is a bispecific monoclonal antibody that mimics the function of factor VIII by binding to factor IXa and factor X to achieve haemostasis in haemophilia A. The long half-life and subcutaneous mode of administration makes emicizumab a compelling treatment option for bleeding prophylaxis. There is still limited real-world data on its use and management considerations, especially during surgical procedures. The objective of the study is to describe the real-world experience of emicizumab in a cohort of adult and paediatric haemophilia A patients in Singapore, including its use in the periprocedural setting., Method: This was an observational study conducted at the 2 main haemophilia treatment centres in Singapore. All haemophilia A patients who commenced treatment with emicizumab before 1 July 2022 were recruited., Results: A total of 18 patients with haemophilia A were included in this study. Ten (55.6%) patients had active inhibitors. The median annual bleeding rate for all patients before emicizumab use was 4.5 events (interquartile range [IQR] 2.8-8.3) compared with 0 events (IQR 0-0) after emicizumab was commenced (P=0). There were no adverse events of venous or arterial thrombosis, thrombotic microangiopathy, or death. A total of 6 procedures in 5 patients were performed during the study period with no major bleeding complications., Conclusion: Emicizumab effectively protects against bleeding in haemophilia A patients with and without inhibitors, including in children less than 12 years old. More studies are required to address clinical nuances, such as periprocedural management and the role of immune tolerance in patients with inhibitors on emicizumab.

Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

To address the issue of bleeding from the vena cava, a common complication of cardiac and aortic surgeries, we developed a sutureless repair technique using Hydrofit, an elastomeric sealant. In a porcine model, we surgically incised the inferior vena cava and applied the elastomeric sealant with a pericardial patch, achieving complete haemostasis through manual compression. This simple and rapid technique demonstrates effective sutureless haemostasis for the vena cava., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Purpose To evaluate in vitro cytotoxicity/biocompatibility as well as in vivo tolerability of the novel polysaccharide 4DryField® PH, certified for haemostasis and adhesion prevention. Methods In vitro cytotoxicity/viability testing according to ISO EN 10,993 using murine and human tumour cell lines incubated with 4DryField® PH (PlantTec Medical GmbH). Using a rat model the impact of 4DryField® PH on animals viability and in vivo effects were macro- and micropathologically assessed. Results In vitro testing revealed no cytotoxic effect of 4DryField® PH nor enhancement of viability to tumour cell lines. In vivo viability of rats was unimpaired by 4DryField® PH. Bodyweight loss in animals with abdominal injury plus treatment with 4DryField® PH was in the range of controls and less than in injured rats without treatment. At day 7 after surgery no formation of adhesions, neither macroscopic nor histological remnants nor signs of foreign body reaction were present in animals without injury. In animals with peritoneal injury and 4DryField® PH application, histopathological observation revealed minor residuals of polysaccharide in the depth of wound cavity embedded in a thickened subperitoneal layer; however, with a suggested intact neoperitoneum. The presence of mononuclear cells surrounding polysaccharide particles in varying states of degradation was observable as well. Conclusion 4DryField® PH is not cytotoxic and does not enhance viability of tumour cell lines. High dose of 4DryField® PH of 1.09 g/kg bodyweight is well tolerated and reduces weight loss in animals with peritoneal injury. The biocompatibility of 4DryField® PH can be rated as being excellent. [ABSTRACT FROM AUTHOR]

Objective To assess the use of local haemostatic agents ( HAs) in a prospective multicentre large series of partial nephrectomies ( PNs)., Patients and Methods Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy ( NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010., In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed., Results The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm., An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024)., In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%)., One or more additional haemostatic action(s) was needed in 12.3% of the cases., When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size ( P = 0.542), collecting system drainage ( P = 0.538), hospital stay ( P = 0.508), operation time ( P = 0.169), blood loss ( P = 0.387) or transfusion rate ( P = 0.713)., Conclusion HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated. [ABSTRACT FROM AUTHOR]

Background: Recently studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, thus NSS is widely accepted as the treatment option for these patients. With NSS, there is a risk of renal hemorrhage and thus haemostatic agents may be routinely applied to the cut surface of the kidney. Herein we compare two commercially available haemostatic agents applied intra-operatively to the cut surface of the kidney. Post-operative outcomes (oncologic and non-oncologic) are reported. Methods: The medical records of 23 patients with suspicious renal mass documented on axial imaging and who underwent open NSS via a mini-subcostal incision were extensively reviewed. One of two haemostatic agents (Floseal®, n = 11; Arista®, n = 12) was intra-operatively applied to the cut surface of the kidney. Chi-square and T- student test was used to compare outcomes between the cohort of 11 patients who had Floseal® and the 12 patients who had Arista®. Results: Median pre-operative size of renal mass was 4.3 cm (range 1.5-7.0 cm). Final pathology revealed 3 oncocytomas and 20 renal cell carcinoma (17 clear cell, 1 chromophobe and 2 papillary), pT1a = 14 and pT1b = 6. Mean intra-operative blood loss and hospital stay between the Floseal® vs. Arista® cohorts did not significantly differ (227 mL vs. 250 mL, p = 0.68 and 4.4 days vs. 4.5 days, p = 0.76, respectively). Intra-operative and post-operative complications were not different between the two cohorts. No recurrences have been documented with a mean follow-up of 18 months. Conclusion: Along with meticulous surgical technique, the use of either haemostatic agent (Floseal® or Arista®) was not associated with high rate of intra-operative or post-operative haemorrhage. Thus either haemostatic agent may be successfully used during NSS. [ABSTRACT FROM AUTHOR]

Abstract: Strict intra-operative haemostasis is essential in the practice of neurosurgery. Over the last century, haemostatic methods have advanced significantly and the modern surgeon is now faced with an array of haemostatic agents, each with subtly different qualities and proven in different contexts with various levels of evidence. The popularity of endoscopic and laparoscopic procedures in other surgical specialties has encouraged the introduction of novel agents to achieve haemostasis where conventional methods have proven difficult. These agents are beginning to find a role in routine use for surgery in both the elective and emergent settings. This article reviews the mechanisms of different haemostasis methods and the current evidence for their use in neurosurgery, with a focus on the more recently introduced gelatin-thrombin matrix sealant (Floseal® [Baxter, Hayward, CA, USA]). [Copyright &y& Elsevier]

Aim: The aim of this in vitro study was to evaluate the microleakage of two different generation bonding agents in the presence of various surface contaminants. Materials and Methods: Class V cavities were prepared on 150 extracted human permanent molars. The samples were randomly divided into two main groups of 75 teeth each. Group I: Fifth generation bonding system (Single Bond, 3M). Group II: Seventh generation bonding system (iBond, Kulzer). Subgroups were formed according to exposure to different surface contaminants (saliva, blood, caries disclosing agent and haemostatic agent). Cavities were restored with hybrid composite (Z-100, 3M) and evaluated for microleakage. The scores were subjected to 't' test and analysis of variance (ANOVA) test. Results: Single Bond and iBond did not provide complete resistance to microleakage when there was no contamination. Microleakage was minimum in the no contamination subgroup and maximum with the haemostatic agent subgroup for both the groups. Conclusion: Single bond showed lesser micro leakage in contaminated conditions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effect of the application of a new hemostatic agent, Ankaferd Blood Stopper (ABS), on the clinical and radiographic success of calcium hydroxide (CH) pulpotomies in primary molars. Methods: Patients with bilateral vital mandibular primary molar teeth that required pulpotomies, because of pulpal exposure to caries, were selected for this study. After initial hemorrhage control, complete hemostasis into the canal orifice was achieved by: (1) applying a solution of ABS for 10 to 15 seconds; or (2) placing sterile, saline-wetted cotton pellets. Forty teeth in 2 groups were followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Results: CH group teeth had a total success rate of 90% at 12 months. CH+ABS group teeth had a total success rate of 95% at 12 months. There were no statistically significant differences between CH and CH+ABS group regarding both clinical and radiographic success rates. Conclusion: Ankaferd Blood Stopper may be a useful product in the management of pulpal bleeding during a calcium hydroxide pulpotomy. [ABSTRACT FROM AUTHOR]

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OBJECTIVE To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper® (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds. MATERIALS AND METHODS In all, 20 male Sprague–Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin. RESULTS The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively ( P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 ( P = 0.21) as well as in the PWs of each group ( P = 0.066). CONCLUSIONS ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue. [ABSTRACT FROM AUTHOR]

Aim To compare the haemostatic effect and tissue reactions of different agents and methods used for haemorrhage control in apical surgery. Methodology Six standardized bone defects were prepared in the calvaria of six Burgundy rabbits. Five haemostatic modalities were tested for their haemostatic effect and tissue reactions, and were compared with untreated control defects: ExpasylTM + Stasis®, ExpasylTM + Stasis® + freshening of the bone defect with a bur, Spongostan®, Spongostan® + epinephrine, and electro cauterization. The haemostatic effect was analysed visually and compared using Wilcoxon’s signed rank test. Two groups of three animals were evaluated histologically for hard and soft tissue reactions related to the different haemostatic measures, after 3 and 12 weeks of healing respectively. Results ExpasylTM + Stasis® and electro cauterization proved most effective in reducing bleeding ( P < 0.05), but were accompanied by unfavourable tissue reactions, as indicated by the presence of necrotic bone, inflammatory cells and the absence of bone repair. These adverse tissue reactions did not recover substantially over time. However, adverse reactions were not observed when the superficial layer of bone had been removed with a rotary instrument. In contrast, Spongostan® + epinephrine showed only a moderate haemostatic effect, but elicited also only mild adverse tissue reactions. Conclusions Haemostasis in experimental bone defects is most effectively accomplished by using ExpasylTM + Stasis® or electro cauterization. However, the bone defects should be freshened with a rotary instrument before suturing so as not to compromise healing. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to determine the incidence of postoperative bleeding after oral surgery under local anaesthesia performed in outpatients with haemostatic disorders within a 5-year period (2003–2007). One hundred twenty one (70 males, 51 females) out of 2,056 outpatients with different haemostatic disorders (acquired or hereditary) were included in this study. The following data were recorded: medical history and general condition; medications; indication for the surgical procedure; specification of local anaesthesia; applied surgical techniques, considering the kind of haemostatic disorder; and peri- or postoperative bleeding complications. Postoperative bleeding was observed in 12 patients (9.9%). In three cases, inpatient treatment became necessary. The management of two patients with a haemostatic disorder (von Willebrand´s disease and haemophilia A) is presented in short case reports. In a heterogeneous group of 121 outpatients with known haemostatic disorders, a combination of a few haemostatic agents with appropriate operative technique enables an effective wound management. In cases of failed local interventions after postoperative bleeding, further diagnostic investigations are required. [ABSTRACT FROM AUTHOR]

Until recently, surgery in haemophilia patients with inhibitors was strongly contraindicated and was therefore often not even contemplated. Inhibitor patients entering the surgical arena face unique challenges; the most frequently encountered problem during surgical intervention is bleeding, and thrombosis is occasionally observed. The activated prothrombin complex concentrate, FEIBA TM, and recombinant activated factor VII (rFVIIa) are available as haemostatic cover during surgery. The use of rFVIIa enables inhibitor patients to undergo orthopaedic surgery with an expectation of success, and results are generally good. An organized team approach is critical to this success. However, further information is required to enable different procedures to be optimized in terms of both outcome and safety. [ABSTRACT FROM AUTHOR]