title: Development of haemostatic decontaminants for the treatment of wounds contaminated with chemical warfare agents. 1: evaluation of in vitro clotting efficacy in the presence of certain contaminants.
abstract: The treatment of penetrating, haemorrhaging injuries sustained within a hazardous environment may be complicated by contamination with toxic chemicals. There are currently no specific medical countermeasures for such injuries. Haemostats with an absorbent mechanism of action have the potential to simultaneously stop bleeding and decontaminate wounds. However, a primary requirement of a 'haemostatic decontaminant' is the retention of clotting function in the presence of chemical contaminants. Thus, the aim of this study was to investigate the haemostatic efficacy of seven commercially available haemostats in the presence of toxic chemicals (soman, VX, sulphur mustard, petrol, aviation fuel and motor oil). Clot viscosity was assessed ex vivo using thrombelastography following treatment of pig blood with: (i) toxic chemical; (ii) haemostat; or (iii) haemostat in combination with toxic chemical. Several contaminants (VX, petrol and GD) were found to be pro-haemostatic and none had an adverse effect on the rate with which the test products attained haemostasis. However, the total clot strength for blood treated with certain haemostats in the presence of sulphur mustard, soman and petrol was significantly decreased. Three test products failed to demonstrate haemostatic function in this ex vivo (thrombelastography) model; this was tentatively ascribed to the products achieving haemostasis through a tamponade mechanism of action, which can only be replicated using in vivo models. Overall, this study has identified a number of commercial products that may have potential as haemostatic decontaminants and warrant further investigation to establish their decontaminant efficacy.
authors.affiliation: CBRN & Chemical Toxicological Research Group, Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency, Chilton, UK; School of Biosciences, University of Birmingham, Birmingham, UK.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Hall
authors.forename: Helen L
authors.initials: HL
authors.lastname: Lydon
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Dalton
authors.forename: J K
authors.initials: JK
authors.lastname: Chipman
authors.forename: John S
authors.initials: JS
authors.lastname: Graham
authors.forename: Robert P
authors.initials: RP
authors.lastname: Chilcott
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D002619:Chemical Warfare Agents / Q000633:toxicity*; D003666:Decontamination / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000494:pharmacology*; D009151:Mustard Gas / Q000633:toxicity; D009946:Organothiophosphorus Compounds / Q000633:toxicity; D010577:Petrolatum / Q000633:toxicity; D012999:Soman / Q000633:toxicity; D013552:Swine; D014947:Wounds and Injuries / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology
chemical_list: D002619:Chemical Warfare Agents; D006490:Hemostatics; D009151:Mustard Gas; D009946:Organothiophosphorus Compounds; D010577:Petrolatum; D012999:Soman; C009680:VX-agent
keywords: chemical warfare agents; haemostasis, decontamination; thrombelastography; toxic industrial chemicals