Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Uncontrolled haemorrhage as a result of trauma remains a significant surgical challenge, accounting for approximately 25–40 % of trauma-related mortality. A wide range of local internal haemostatic agents have been developed to help achieve intra-cavity control of bleeding, with choice of agent influenced by the circumstances and nature of the haemorrhage. Trauma patients are frequently coagulopathic, so products that incorporate pro-coagulant technology and thereby act independently of the clotting cascade may be more effective in these settings. A range of products that utilise thrombin and fibrinogen to promote local haemostasis at intra-cavity bleeding points are available or in development, including fibrin glues (e.g. Tisseel®/Tissucol® and Evicel®/Crosseal®/Quixil®), fibrin sealant patches (e.g. TachoSil®) and products based on a gelatin-thrombin haemostatic matrix (e.g. FloSeal®).

Materials and methods

This systematic review was performed to assess all peer-reviewed evidence of product efficacy.

Results

Fibrin sealant patches have shown haemostatic efficacy in a variety of surgical procedures and appear to offer practical advantages over liquid fibrin glues. Existing evidence suggests that patch products enable delivery of pro-coagulants 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.

Conclusions

Our experience, supported by other reports in the literature, suggests the use of such fibrin patches may provide an effective option in helping to control haemorrhage after trauma. However, there is a general paucity of clinical data for intra-cavity haemostatic agent use, with the majority of data being based on animal models and case reports. Further clinical evidence, ideally including comparative studies between different agents, would be beneficial in helping guide surgeon choice to the most appropriate products to use in trauma settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg. 2007;31:2092–103.

    Article  PubMed  Google Scholar 

  2. Chalkley D, Cheung G, Walsh M, Tai N. Deaths from trauma in London—a single centre experience. Emerg Med J. 2011;28:305–9.

    Article  PubMed  Google Scholar 

  3. Lee JC, Peitzman AB. Damage-control laparotomy. Curr Opin Crit Care. 2006;12:346–50.

    Article  PubMed  Google Scholar 

  4. Waibel BH, Rotondo MF. Damage control in trauma and abdominal sepsis. Crit Care Med. 2010;38(Suppl):S421–30.

    Article  PubMed  Google Scholar 

  5. Bowley DM, Barker P, Boffard KD. Damage control surgery—concepts and practice. J R Army Med Corps. 2000;146:176–82.

    Article  CAS  PubMed  Google Scholar 

  6. Tapia NM, Suliburk J, Mattox KL. The initial trauma center fluid management of penetrating injury: a systematic review. Clin Orthop Relat Res. 2013;471(12):3961–73.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kheirabadi BS, Pusateri AE, Sondeen JL, Delgado AV, Modrow HE, Hess JR, et al. Development of hemostatic dressings for use in military operations. NATO/ORAN, RTO-MP-HFM-109, 2004. http://rta.nato.int/public/Pubfulltext/RTO/MP/RTO-MP-HFM-109///MP-HFM-109-P34.pdf. Accessed June 2013.

  8. Granville-Chapman J, Jacobs N, Midwinter MJ. Pre-hospital haemostatic dressings: a systematic review. Injury. 2011;42:447–59.

    Article  CAS  PubMed  Google Scholar 

  9. Smith AH, Laird C, Porter K, Bloch M. Haemostatic dressings in prehospital care. Emerg Med J. 2012;. doi:10.1136/emermed-2012-201581.

    PubMed Central  Google Scholar 

  10. Seyednejad H, Imani M, Jamieson T, Seifalian AM. Topical haemostatic agents. Br J Surg. 2008;95:1197–225.

    Article  CAS  PubMed  Google Scholar 

  11. Canonico S, Sciaudone G, Pacifico F, Santoriello A. Inguinal hernia repair in patients with coagulation problems: prevention of postoperative bleeding with human fibrin glue. Surgery. 1999;125:315–7.

    Article  CAS  PubMed  Google Scholar 

  12. Walshe P, Harkin C, Murphy S, Shah C, Curran A, McShane D. The use of fibrin glue in refractory coagulopathic epistaxis. Clin Otolaryngol Allied Sci. 2001;26:284–5.

    Article  CAS  PubMed  Google Scholar 

  13. Codispoti M, Mankad PS. Significant merits of a fibrin sealant in the presence of coagulopathy following paediatric cardiac surgery: randomised controlled trial. Eur J Cardiothorac Surg. 2002;22:200–5.

    Article  CAS  PubMed  Google Scholar 

  14. Ochsner MG, Maniscalco-Theberge ME, Champion HR. Fibrin glue as a hemostatic agent in hepatic and splenic trauma. J Trauma. 1990;30:884–7.

    Article  CAS  PubMed  Google Scholar 

  15. Kheirabadi BS, Field-Ridley A, Pearson R, MacPhee M, Drohan W, Tuthill D. Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model. J Surg Res. 2002;106:99–107.

    Article  CAS  PubMed  Google Scholar 

  16. European Medicines Agency. European Medicines Agency recommends new advice to surgeons on safer use of fibrin sealants Evicel and Quixil. http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2012/11/WC500134851.pdf. Accessed June 2013.

  17. Frilling A, Stavrou GA, Mischinger HJ, de Hemptinne B, Rokkjaer M, Klempnauer J, et al. Effectiveness of a new carrier-bound fibrin sealant versus argon beamer as haemostatic agent during liver resection: a randomised prospective trial. Langenbecks Arch Surg. 2005;390:114–20.

    Article  PubMed  Google Scholar 

  18. Siemer S, Lahme S, Altziebler S, Machtens S, Strohmaier W, Wechsel HW, et al. Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney tumour resection: a randomised prospective study. Eur Urol. 2007;52:1156–63.

    Article  CAS  PubMed  Google Scholar 

  19. Maisano F, Kjaergård HK, Bauernschmitt R, Pavie A, Rábago G, Laskar M, et al. TachoSil surgical patch versus conventional haemostatic fleece material for control of bleeding in cardiovascular surgery: a randomised controlled trial. Eur J Cardiothorac Surg. 2009;36(4):708–14.

    Article  PubMed  Google Scholar 

  20. Marta GM, Facciolo F, Ladegaard L, Dienemann H, Csekeo A, Rea F, et al. Efficacy and safety of TachoSil® versus standard treatment of air leakage after pulmonary lobectomy. Eur J Cardiothorac Surg. 2010;38:683–9.

    Article  PubMed  Google Scholar 

  21. Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, et al. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011;149:48–55.

    Article  PubMed  Google Scholar 

  22. Rickenbacher A, Breitenstein S, Lesurtel M, Frilling A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery—a systematic review. Expert Opin Biol Ther. 2009;9:897–907.

    Article  CAS  PubMed  Google Scholar 

  23. Schiele U, Kuntz G, Riegler A. Haemostyptic preparations on the basis of collagen alone and as fixed combination with fibrin glue. Clin Mater. 1992;9:169–77.

    Article  CAS  PubMed  Google Scholar 

  24. Carbon RT, Baar S, Kriegelstein S, Huemmer HP, Baar K, Simon SI. Evaluating the in vitro adhesive strength of biomaterials. Biosimulator for selective leak closure. Biomaterials. 2003;24:1469–75.

    Article  CAS  PubMed  Google Scholar 

  25. Carbon R, Kriegelstein S, Baar S, Schmidt A, Weber P, Huemmer HP. Tissue management with fleece-bound sealing: Materials, material science and clinical implementation. In: Faist E, editor. 6th World Congress on Trauma, Shock, Inflammation and Sepsis: Pathophysiology, immune consequences and therapy. Bologne: Monduzzi Editore-Medimond; 2004.

    Google Scholar 

  26. Grottke O, Braunschweig T, Daheim N, Coburn M, Grieb G, Rossaint R, et al. Effect of TachoSil in a coagulopathic pig model with blunt liver injuries. J Surg Res. 2011;171:234–9.

    Article  CAS  PubMed  Google Scholar 

  27. Agger P, Langhoff J, Smerup MH, Hasenkam JM. Comparison between TachoComb and TachoSil for surgical hemostasis in arterial bleeding: an animal experimental study. J Trauma. 2010;68:838–42.

    Article  PubMed  Google Scholar 

  28. Frena A, Martin F. How to improve bilio-stasis in liver surgery. Chir Ital. 2006;58:793–5.

    PubMed  Google Scholar 

  29. Carbon RT, Baar S, Waldschmidt J, Huemmer HP, Simon SI. Innovative minimally invasive pediatric surgery is of therapeutic value for splenic injury. J Pediatr Surg. 2002;37:1146–50.

    Article  PubMed  Google Scholar 

  30. Brückner B. Biological tissue glues—an outline of personal experience with the preparation TachoComb. Int Rev Armed Forces Med Services. 1995;68(10–12):323–7.

    Google Scholar 

  31. Stannard A, Ramasamy A, Edwards D, Hinsley D, Midwinter M, Brooks A. Tachosil use on operational deployment. Presented at the Association of Military Surgeons, Military Surgery Conference, UK, 2009.

  32. Larson MJ, Bowersox JC, Lim RC Jr, Hess JR. Efficacy of a fibrin hemostatic bandage in controlling hemorrhage from experimental arterial injuries. Arch Surg. 1995;130:420–2.

    Article  CAS  PubMed  Google Scholar 

  33. Jackson MR, Friedman SA, Carter AJ, Bayer V, Burge JR, MacPhee MJ, et al. Hemostatic efficacy of a fibrin sealant-based topical agent in a femoral artery injury model: a randomized, blinded, placebo-controlled study. J Vasc Surg. 1997;26:274–80.

    Article  CAS  PubMed  Google Scholar 

  34. Holcomb JB, Pusateri AE, Hess JR, Hetz SP, Harris RA, Tock BB, et al. Implications of new dry fibrin sealant technology for trauma surgery. Surg Clin North Am. 1997;77:943–52.

    Article  CAS  PubMed  Google Scholar 

  35. Holcomb JB, Pusateri AE, Harris RA, Charles NC, Gomez RR, Cole JP, et al. Effect of dry fibrin sealant dressings versus gauze packing on blood loss in grade V liver injuries in resuscitated swine. J Trauma. 1999;46:49–57.

    Article  CAS  PubMed  Google Scholar 

  36. Pusateri AE, Modrow HE, Harris RA, Holcomb JB, Hess JR, Mosebar RH, et al. Advanced hemostatic dressing development program: animal model selection criteria and results of a study of nine hemostatic dressings in a model of severe large venous hemorrhage and hepatic injury in Swine. J Trauma. 2003;55:518–26.

    Article  CAS  PubMed  Google Scholar 

  37. Sondeen JL, Pusateri AE, Coppes VG, Gaddy CE, Holcomb JB. Comparison of 10 different hemostatic dressings in an aortic injury. J Trauma. 2003;54:280–5.

    Article  PubMed  Google Scholar 

  38. Kheirabadi BS, Acheson EM, Deguzman R, Sondeen JL, Ryan KL, Delgado A, et al. Hemostatic efficacy of two advanced dressings in an aortic hemorrhage model in Swine. J Trauma. 2005;59:25–34.

    Article  PubMed  Google Scholar 

  39. McManus JG, Wedmore I. Modern hemostatic agents for hemorrhage control—a review and discussion of use in current combat operations. Emerg Med Review 2005;1–4.

  40. Delgado AV, Kheirabadi BS, Fruchterman TM, Scherer M, Cortez D, Wade CE, et al. A novel biologic hemostatic dressing (fibrin patch) reduces blood loss and resuscitation volume and improves survival in hypothermic, coagulopathic Swine with grade V liver injury. J Trauma. 2008;64:75–80.

    Article  CAS  PubMed  Google Scholar 

  41. Floyd CT, Rothwell SW, Martin R, Risdahl J, Olson CE. A salmon thrombin-fibrinogen dressing controls hemorrhage in a swine model compared to standard kaolin-coated gauze. J Spec Oper Med. 2012;12:49–55.

    PubMed  Google Scholar 

  42. Floyd CT, Rothwell SW, Risdahl J, Martin R, Olson C, Rose N. Salmon thrombin-fibrinogen dressing allows greater survival and preserves distal blood flow compared to standard kaolin gauze in coagulopathic swine with a standardized lethal femoral artery injury. J Spec Oper Med. 2012;12:16–26.

    PubMed  Google Scholar 

  43. Koea JB, Batiller J, Patel B, Shen J, Hammond J, Hart J, et al. A phase III, randomized, controlled, superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery. HPB (Oxford). 2013;15:61–70.

    Article  Google Scholar 

  44. Fischer CP, Bochicchio G, Shen J, Patel B, Batiller J, Hart JC. A prospective, randomized, controlled trial of the efficacy and safety of fibrin pad as an adjunct to control soft tissue bleeding during abdominal, retroperitoneal, pelvic, and thoracic surgery. J Am Coll Surg. 2013;217:385–93.

    Article  PubMed  Google Scholar 

  45. Ollinger R, Mihaljevic AL, Schuhmacher C, Bektas H, Vondran F, Kleine M, et al. A multicentre, randomized clinical trial comparing the Veriset™ haemostatic patch with fibrin sealant for the management of bleeding during hepatic surgery. HPB (Oxford). 2013;15:548–58.

    Article  Google Scholar 

  46. Oz MC, Cosgrove DM 3rd, Badduke BR, Hill JD, Flannery MR, Palumbo R, et al. Controlled clinical trial of a novel hemostatic agent in cardiac surgery. The Fusion Matrix Study Group. Ann Thorac Surg. 2000;69:1376–82.

    Article  CAS  PubMed  Google Scholar 

  47. Weaver FA, Hood DB, Zatina M, Messina L, Badduke B. Gelatin-thrombin-based hemostatic sealant for intraoperative bleeding in vascular surgery. Ann Vasc Surg. 2002;16:286–93.

    Article  PubMed  Google Scholar 

  48. Renkens KL Jr, Payner TD, Leipzig TJ, Feuer H, Morone MA, Koers JM, et al. A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery. Spine. 2001;26:1645–50.

    Article  PubMed  Google Scholar 

  49. Gall RM, Witterick IJ, Shargill NS, Hawke M. Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. J Otolaryngol. 2002;31:271–4.

    Article  PubMed  Google Scholar 

  50. Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope. 2005;115:899–902.

    Article  PubMed  Google Scholar 

  51. Pursifull NF, Morris MS, Harris RA, Morey AF. Damage control management of experimental grade 5 renal injuries: further evaluation of FloSeal gelatin matrix. J Trauma. 2006;60:346–50.

    Article  CAS  PubMed  Google Scholar 

  52. Hick EJ, Morey AF, Harris RA, Morris MS. Gelatin matrix treatment of complex renal injuries in a porcine model. J Urol. 2005;173:1801–4.

    Article  CAS  PubMed  Google Scholar 

  53. Leixnering M, Reichetseder J, Schultz A, Figl M, Wassermann E, Thurnher M, et al. Gelatin thrombin granules for hemostasis in a severe traumatic liver and spleen rupture model in swine. J Trauma. 2008;64:456–61.

    Article  CAS  PubMed  Google Scholar 

  54. Woodworth BA, Chandra RK, LeBenger JD, Ilie B, Schlosser RJ. A gelatin-thrombin matrix for hemostasis after endoscopic sinus surgery. Am J Otolaryngol. 2009;30:49–53.

    Article  CAS  PubMed  Google Scholar 

  55. Lewis KM, Atlee HD, Mannone AJ, Dwyer J, Lin L, Goppelt A, et al. Comparison of two gelatin and thrombin combination hemostats in a porcine liver abrasion model. J Invest Surg. 2013;26:141–8.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Prior JJ, Wallace DG, Harner A, Powers N. A sprayable hemostat containing fibrillar collagen, bovine thrombin, and autologous plasma. Ann Thorac Surg. 1999;68:479–85.

    Article  CAS  PubMed  Google Scholar 

  57. Turner AS, Parker D, Egbert B, Maroney M, Armstrong R, Powers N. Evaluation of a novel hemostatic device in an ovine parenchymal organ bleeding model of normal and impaired hemostasis. J Biomed Mater Res. 2002;63:37–47.

    Article  CAS  PubMed  Google Scholar 

  58. CoStasis Multi-center Collaborative Writing Committee. A novel collagen-based composite offers effective hemostasis for multiple surgical indications: Results of a randomized controlled trial. Surgery. 2001;129:445–50.

    Article  Google Scholar 

  59. Chapman WC, Clavien PA, Fung J, Khanna A, Bonham A. Effective control of hepatic bleeding with a novel collagen-based composite combined with autologous plasma: results of a randomized controlled trial. Arch Surg. 2000;135:1200–4.

    Article  CAS  PubMed  Google Scholar 

  60. Dunne JR, Bochicchio GV, Scalea TM. A novel approach to the treatment of gunshot injuries to the sacrum. Am Surg. 2003;69:91–4.

    PubMed  Google Scholar 

  61. Bloomfield MR, Klika AK, Molloy RM, Froimson MI, Krebs VE, Barsoum WK. Prospective randomized evaluation of a collagen/thrombin and autologous platelet hemostatic agent during total knee arthroplasty. J Arthroplast. 2012;27:695–702.

    Article  Google Scholar 

  62. Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010;69:489–500.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Alex Navarro declares that he has no conflict of interest. Adam Brooks has received speaker honorariums, consultancy and promotional fees from Takeda UK Ltd.

Ethical standard

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Author information

Authors and Affiliations

  1. Hepatobiliary Surgery and Major Trauma, Nottingham University Hospitals NHS Trust and East Midlands Major Trauma Centre, Nottingham, UK

    A. Navarro & A. Brooks

Authors
  1. A. Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Brooks
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Navarro.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Navarro, A., Brooks, A. Use of local pro-coagulant haemostatic agents for intra-cavity control of haemorrhage after trauma. Eur J Trauma Emerg Surg 41, 493–500 (2015). https://doi.org/10.1007/s00068-014-0441-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-014-0441-4

Keywords

Search

Navigation