Acute in-vivo evaluation of bleeding with Gelfoam plus saline and Gelfoam plus human thrombin using a liver square lesion model in swine.

Journal Article

BACKGROUND: Management of post-operative bleeding has historically used topical bovine thrombin. However, possible harm through activation of coagulation inhibitors has encouraged investigation with other hemostatic agents. This study utilized a novel ordinal bleeding model to test whether a Gelfoam + human thrombin solution is superior at controlling bleeding when compared to Gelfoam + saline solution at different time intervals. STUDY DESIGN: Four swine underwent open laparotomy after receiving unfractionated heparin. Twenty open liver biopsies were performed in each swine; ten biopsies treated with Gelfoam + human thrombin solution and 10 biopsies treated with Gelfoam + saline solution. Three, 6 min, and 12 min after the procedure, bleeding was objectively graded by a four-point model. RESULTS: There was a significant (P < 0.017), treatment effect on each success/failure outcome (success = bleeding score 1) at 3 (P < 0.001), 6 (P < 0.001), and 12 (P = 0.003) min, based on a 2 x 2 Fisher's exact test. Similarly, there was a significant treatment effect on each success/failure outcome and four-point bleeding score based on a multiple logistic regression analysis controlling for pig, lesion weight, and initial bleeding taking into consideration repeated measures at three time points. CONCLUSIONS: The results demonstrate a superior treatment effect for control of bleeding using human thrombin compared to a saline solution. Future studies should compare bovine thrombin versus human thrombins ability to control bleeding as well as the hazard of each in activating coagulation inhibitors.

Full Text

Duke Authors

Cited Authors

  • Adams, GL; Manson, RJ; Hasselblad, V; Shaw, LK; Lawson, JH

Published Date

  • July 2009

Published In

Volume / Issue

  • 28 / 1

Start / End Page

  • 1 - 5

PubMed ID

  • 18629446

Electronic International Standard Serial Number (EISSN)

  • 1573-742X

Digital Object Identifier (DOI)

  • 10.1007/s11239-008-0249-3

Language

  • eng

Conference Location

  • Netherlands