Comparison of the Effects of Hemostatic Agents in Experimental Splenic Injuries in Rat Models

Year 2020, , 161 - 166, 20.08.2020

Mustafa Alimoğulları , Gökhan Akkurt

https://doi.org/10.35440/hutfd.694637

Cited By: 1

Abstract

Background: One of the most common causes of trauma related deaths is hemorrhage due to splenic injury. The aim of the study was to compare the effects of hemostatic activities of Ankaferd blood stopper (ABS®), Oxidized Cellulose (Surgicel®) and FloSeal® in rats with experimental splenic injuries.
Materials and Methods: In this study we used twenty four female Wistar Albino rats. Grade 2 spleen laceration was performed on all rats. Rats were randomly divided into four groups each consist of 6 rats, as control, ABS, Surgicel and FloSeal. After performing grade 2 spleen laceration, sponge compression was applied to the control group and hemostatic agents were applied to the other groups. The amount and duration of bleeding and preoperative-postoperative hematocrit (Hct) levels were statistically compared between the groups.
Results: The amount and duration of bleeding was at least in the group using FloSeal, followed by ABS, Surgicel and control group, respectively. The amount of bleeding was; 0.27±0.04gr, 0.38±0.08gr, 0.63±0.09gr and 1.0±0.2gr respectively. The duration of bleeding was; 65.66±10.63s, 70.16±8.13s, 214.00±17.98s and 381.83±59.09s respectively. The amount and duration of bleeding was less in all groups using hemostatic agent compared to the control group (p<0.001). In the groups using FloSeal and ABS, the amount and duration of bleeding were significantly lower than Surgicel group (the amount of bleeding was p<0.001 and p=0.011, bleeding time p<0.001 and p<0.001, respectively). Although the amount and duration of bleeding was found at least in the FloSeal group but this difference was not statistically significant when compared with ABS group (bleeding amount p=0.476, duration p=0.842).
Conclusion: In our study, hemostatic agents that can be used in hemorrhage due to splenic laceration were found much more effective in stopping bleeding than the control group. In particularly, it was observed that FloSeal and ABS provide hemostasis and reduce the amount of bleeding more effectively than oxidized cellulose.

Keywords

Ankaferd, FloSeal, Hemostasis, Oxidized cellulose

Deneysel Dalak Yaralanması Yapılan Ratlarda Hemostatik Ajanların Etkinliğinin Karşılaştırılması

Abstract

Amaç: Travmaya bağlı ölümlerde en sık görülen nedenlerden birisi dalak yaralanmasına bağlı kanamalardır. Çalışmamızda deneysel dalak yaralanması yapılan ratlarda; Ankaferd blood stopper (ABS®), Oksidize Selüloz (Surgicel®) ve FloSeal®’ın hemostatik etkinliklerinin karşılaştırılması amaçlandı.
Materyal ve metod: 24 Wistar Albino Ratda grade 2 dalak laserasyonu oluşturuldu; Tüm ratlar; kontrol, ABS, Surgicel ve FloSeal kullanılan olmak üzere, her grupta rastgele 6 rat olacak şekilde 4 gruba ayrıldı. Dalakta grade 2 laserasyon yapıldıktan sonra kontrol grubunda spanç kompresyonu, diğer gruplarda hemostatik ajanlar kullanıldı. Gruplar arası; kanama miktarı, süresi ile preoperatif-postoperatif hematokrit (Hct) seviyeleri istatistiksel olarak karşılaştırıldı.
Bulgular: Kanama miktarı ve süresi en az FloSeal kullanılan grupta, ardından sırayla ABS, Surgicel ve kontrol grubunda idi. Kanama miktarları sırasıyla; 0.27±0.04gr, 0.38±0.08gr, 0.63±0.09gr ve 1.0±0.2gr iken kanama süreleri sırasıyla; 65.66±10.63s, 70.16±8.13s, 214.00±17.98s ve 381.83±59.09s idi. Hemostatik ajan kullanılan grupların tümünde kanama miktarı ve süresi kontrol grubuna göre daha az saptandı (p<0.001). FloSeal ve ABS kullanılan gruplarda ise kanama miktarı ve süresi Surgicel’e göre anlamlı olarak azdı (kanama miktarı sırasıyla p<0.001 ve p=0.011, kanama süresi p<0.001 ve p<0.001). Kanama miktarı ve süresi en az FloSeal grubunda saptanmasına rağmen ABS ile kıyaslandığında bu fark istatistiksel olarak anlamlı değildi (kanama miktarı p=0.476, süresi p=0.842)
Sonuç: Çalışmamızda, dalak laserasyonuna bağlı kanamalarda kullanılabilen hemostatik ürünlerin, kanamayı durdurmada kontrol grubuna göre çok daha etkin olduğu görüldü. Hemostatik ajanlardan FloSeal başta olmak üzere, ABS’nin de Surgicel’e göre daha etkin bir şekilde hemostazı sağladığı ve kanama miktarını azalttığı da gözlemlendi.

Keywords

Ankaferd, Dalak, FloSeal, Hemostaz, Oksidize selüloz

References

• 1- Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology 2012; 265(3):678–693.
• 2- Boscak A, Shanmuganathan K. Splenic trauma: what is new? Radiol Clin N Am 2012;50(1):105 –122.
• 3- Modi P, Rahamim J. Fibrin sealant treatment of splenic injuries during oesophagectomy. Eur J Cardiothorac Surg 2005;28(1):167–168.
• 4- Hildebrand P, Roblick UJ, Schloricke E, Czymek R, Bruch HP, Burk C. The role of organ preservation in the surgical therapy of traumatic spleen injury. Acta Chir Iugosl 2011;58(4):21–25.
• 5- Kraus TW, Mehrabi A, Schemmer P, Kashfi A, Berberat P, Buchler MW. Scientific evidence for application of topical hemostats, tissue glues, and sealants in hepatobiliary surgery. J Am Coll Surg 2005;200(3):418–427.
• 6- Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC. Evaluation of hemostatic effects of Ankaferd as an alternative medicine. Altern Med Rev 2010;15:329–336.
• 7- Takacs I, Wegmann J, Horvath S, Ferencz A, Ferencz S, Javor S, et al. Efficacy of different hemostatic devices for severe liver bleeding: a randomized controlled animal study. Surg Innov 2010;17:346–352.
• 8- Barnard J, Millner R. A review of topical hemostatic agents for use in cardiac surgery. Ann Thorac Surg 2009;88(4):1377-1383.
• 9- Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg 2005;200(5):648–669.
• 10- Leonard AS, Giebink GS, Baesl TJ, Krivit W. The overwhelming postsplenectomy sepsis problem. World J Surg 1980;4(4):423–432.
• 11- Kohno H, Nagasue N, Chang YC, Taniura H, Yamanoi A, Nakamura T. Comparison of topical hemostatic agents in elective hepatic resection: a clinical prospective randomized trial. World J Surg., 1992; 16: 966-9.
• 12- Karakaya K, Ucan HB, Tascilar O, Emre AU, Cakmak GK, Irkorucu O, et al. Evaluation of a new hemostatic agent Ankaferd Blood Stopper in experimental liver laceration. J Invest Surg 2009; 22:201–206.
• 13- Moore K.L, Dalley A.F. Kliniğe yönelik anatomi. 3. Baskı, Nobel Tıp Kitabevleri. S:263- 271: 2007.
• 14- Satar N, Akkoc A, Oktay A, Topal A, İnan K. Evaluation of the hemostatic and histopathological effects of Ankaferd Blood Stopper in experimental liver injury in rats. Blood Coagul Fibrinolysis 2013, 24:518–524.
• 15- Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Gharabaghi N et al. Hemostatic efficiency of modern topical sealants: Comparative evaluation after liver resection and splenic laceration in a swine model. J Biomed Mater Res Part B 2017:00B:000–000. DOI: 10.1002/jbm.b.33937.
• 16- Dorterler ME, Ayangil HR, Turan C, Deniz K. Comparison of the hemostatic effects of oxidized cellulose and calcium alginate in an experimental animal model of hepatic parenchymal bleeding. Int J Crit Illn Inj Sci 2016;6:167-71.
• 17- Davidson BR, Burnett S, Javed MS, Seifalian A, Moore D, Doctor N. Experimental study of a novel fibrin sealant for achieving hae-mostasis following partial hepatectomy. Br J Surg 2000;87(6):790–795.
• 18- Mankad PS, Codispoti M. The role of fibrin sealants in hemostasis. Am J Surg 2001;182(2 Suppl):21S–28S.