title: Comparison of two gelatin and thrombin combination hemostats in a porcine liver abrasion model.
abstract: BACKGROUND
  Surgical hemostasis is achieved using adjunctive hemostats when conventional methods fail.
  
  
  OBJECTIVE
  This study compares the effectiveness of two adjunctive gelatin-thrombin hemostats.
  
  
  OBJECTIVE
  To determine effectiveness, hemostats were compared in vivo, in vitro, and using scanning electron microscopy (SEM).
  
  
  METHODS
  In vivo, a heparinized porcine liver abrasion model was used to compare hemostatic success, degree of bleeding, and blood loss at 2, 5, and 10 minutes post-treatment. In vitro, thrombin in the supernatant of each hemostat and Red Blood Cells (RBC'S) in the supernatant of clots formed by each was compared.
  
  
  RESULTS
  Ultrastructure of one gelatin was smooth and the other stellate. In vivo, smooth gelatin provided superior hemostatic success at 5 (85% vs. 60%; OR: 5.3; 95% CI: 1.66 to 17.9) and 10 mins (72.5% vs. 47.5%; OR: 5.0; 95% CI: 1.55 to 16.1). Smooth gelatin had a statistically different degree of bleeding at 5 (0.58 ± 0.87 [Mean ± SD] vs. 1.03 ± 1.12; OR: 3.36; 95% CI: 1.34 to 8.41) and 10 mins (1.13 ± 1.14 vs. 1.65 ± 1.05; OR: 3.87; 95% CI: 1.62 to 9.21). Mean blood loss was less with smooth gelatin at 2 (0.07 ± 0.19 vs. 0.13 ± 0.63 ml/min), 5 (0.04 ± 0.13 vs. 0.23 ± 0.45 ml/min), and 10 mins (0.09 ± 0.24 vs. 0.21 ± 0.32 ml/min). In vitro, supernatant of smooth gelatin had significantly less thrombin (6.81 vs. 10.9 IU/ml, p = .001), and significantly less RBC's than stellate gelatin (0.07 vs. 0.09 × 10(6)/ul, p = .0085).
  
  
  CONCLUSIONS
  Smooth gelatin has an increased ability to retain thrombin and RBC's in vitro which may explain why it provides superior hemostatic effectiveness, superior control of bleeding, and greater reduced blood loss in vivo.
authors.affiliation: Baxter Healthcare Corporation, Deerfield, Illinois 60015, USA. kevin_lewis@baxter.com
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Lewis
authors.forename: Holly D
authors.initials: HD
authors.lastname: Atlee
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Mannone
authors.forename: Joseph
authors.initials: J
authors.lastname: Dwyer
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lin
authors.forename: Andreas
authors.initials: A
authors.lastname: Goppelt
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002417:Cattle; D002627:Chemistry, Physical; D005260:Female; D005780:Gelatin / Q000627:therapeutic use* / Q000648:ultrastructure; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008099:Liver / Q000293:injuries; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D013552:Swine; D013917:Thrombin / Q000627:therapeutic use*
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D005780:Gelatin; D013917:Thrombin