The combination of platelet-enriched autologous plasma with bovine collagen and thrombin decreases the need for multiple blood transfusions in trauma patients with retroperitoneal bleeding.
OBJECTIVE
Bleeding from blunt and penetrating retroperitoneal injuries during operative exploration are often difficult to control surgically and can be associated with significant blood loss. Our goals were to evaluate and compare the efficacy of a topical autologous platelet-enriched plasma combined with bovine collagen and thrombin (PCT) to Gelfoam/thrombin (G/T) in relation to hemostatic control/blood transfusion (BTx) requirements and subsequent outcome.


METHODS
Prospective data were collected on all patients who underwent operative exploration for retroperitoneal injuries in which either PCT or G/T was applied with or without packing over a 2.5-year period. Patients were stratified by age, gender, mechanism of injury, preoperative international normalized ratio, pH, hematocrit, intraoperative blood loss, and BTx requirements. Subsequent BTx requirements were calculated within 48 hours of the surgical procedure. Outcome was measured by intensive care unit and hospital length of stay and mortality.


RESULTS
A total of 78 patients met study criteria. Patients who received G/T had a significantly greater number of early postoperative transfusions (p < 0.001) and a longer hospital (p < 0.001) and intensive care unit length of stay (p < 0.007). There was no difference in mortality.


CONCLUSIONS
PCT is a rapidly available topical hemostat that is associated with a significant decrease in the need for postoperative blood transfusions and intensive care unit and hospital length of stay. A randomized prospective trial to confirm these results is warranted.
Bochicchio
Grant
G
University of Maryland School of Medicine and the R Adams Cowley Shock Trauma Center, Baltimore, 21201, USA. gbochicchio@umm.edu
Dunne
James
J
Bochicchio
Kelly
K
Scalea
Thomas
T
D000328:Adult; D001803:Blood Transfusion; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010949:Plasma; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012187:Retroperitoneal Space / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D013917:Thrombin / Q000627:therapeutic use*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery / Q000628:therapy*
D006490:Hemostatics; D003094:Collagen; D013917:Thrombin