title: Ankaferd blood stopper is more effective than adrenaline plus lidocaine and gelatin foam in the treatment of epistaxis in rabbits.
abstract: BACKGROUND
  Epistaxis is an important emergency that can sometimes be life threatening without effective intervention. Persistent and recurrent bleeding can lead to aspiration, hypotension, hypoxia, or even severe and mortal cardiovascular complications. Providing prompt hemostasis is important, and the hemostatic method used must be easily and locally applicable, efficient, and inexpensive.
  
  
  OBJECTIVE
  The aim of this study was to assess the hemostatic efficacy of Ankaferd Blood Stopper (ABS) in an experimental epistaxis model and to determine the histopathologic alterations with topical ABS application.
  
  
  METHODS
  Twenty-eight New Zealand rabbits were evaluated in 4 study groups. Topical ABS, gelatin foam (GF), adrenalin + lidocaine (AL), and serum physiologic as negative control (C) were applied to the animals for controlling epistaxis. The bleeding was generated with a standard mucosal incision in all groups. Cotton pieces soaked with ABS, AL, C, and GF were applied to the nasal bleeding area. Time of hemostasis was recorded. Tissue samples were obtained after hemostasis for histopathologic examination. The samples were stained with hematoxylin and eosin (HE) and phosphotungstic acid hematoxylin (PTAH) and were examined under a light microscope. In this experimental study, the observers were blind to ABS, AL, and C but not to GF, because of its solid nature.
  
  
  RESULTS
  Median durations required for hemostasis in ABS, AL, GF, and C groups were recorded as 30, 90, 90, and 210 seconds, respectively. The time until termination of bleeding in the ABS group was significantly shorter than that in the AL, GF, and C groups (P = 0.002, P = 0.002, and P = 0.001, respectively). On histopathologic evaluation, after staining with HE, minimal fibrin at the incision edges and a few extravasated erythrocytes were observed in the C, AL, and GF groups. In the ABS group, a dark amorphous material surrounded by fibrin, filling the space between the edges of incisions, was noticed. Fibrin was determined in the C, GF, and AL groups with PTAH stain and in the positive control group. In the ABS group, it was observed that the amorphous substance surrounded by fibrin seen in the HE sections was not stained with PTAH.
  
  
  CONCLUSIONS
  Topical nasal ABS application controlled epistaxis faster than C, GF, and AL in this animal bleeding model. The bleeding model used here might fail to replicate the type of injury that would be likely to result in life-threatening bleeding in humans, which should be considered a limitation of the present study. The histopathologic findings in the nasal incision area suggest that ABS might affect global hemostasis by inducing a unique protein network formation, potentially representing a different mechanism of action among conventional antihemorrhagic applications.
authors.affiliation: Department of Otorhinolaryngology, Inonu University, Malatya, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kelles
authors.affiliation: Department of Otorhinolaryngology, Inonu University, Malatya, Turkey.
authors.forename: M Tayyar
authors.initials: MT
authors.lastname: Kalcioglu
authors.affiliation: Department of Pathology, Inonu University, Malatya, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Samdanci
authors.affiliation: Department of Otorhinolaryngology, Inonu University, Malatya, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Selimoglu
authors.affiliation: Department of Pharmacology, Bezmialem Vakif University, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Iraz
authors.affiliation: Department of Otorhinolaryngology, Kocatepe University, Afyon, Turkey.
authors.forename: Murat Cem
authors.initials: MC
authors.lastname: Miman
authors.affiliation: Department of Hematology, Hacettepe University, Ankara, Turkey.
authors.forename: Ibrahim C
authors.initials: IC
authors.lastname: Haznedaroglu
keywords: Ankaferd Blood Stopper; epinephrine; epistaxis; gelatin foam; lidocaine; rabbit