title: Rapid hemostasis in a sheep model using particles that propel thrombin and tranexamic acid.
abstract: Bleeding during endoscopic sinus surgery and open surgeries can easily obstruct the surgeons' field of view and increase morbidity and risk of intraoperative complications. Intraoperative bleeding could potentially be addressed by a hemostatic agent that safely disperses itself through the escaping blood. We tested the safety and efficacy of a self-propelling formulation of thrombin and tranexamic acid (SPTT) in stopping bleeding in a paranasal sinus injury and in an open surgical carotid injury sheep model.
  
  
  
  Interventional animal study.
  
  
  
  SPTT was tested in the sinonasal space following endoscopic injury to the inferior turbinate of six sheep, and to the common carotid artery following open surgical injury in eight sheep. In the nasal cavity, bleeding time and local inflammation were measured and compared to plain gauze. Following carotid arteriotomy, successful hemostasis and markers of thrombosis and coagulopathy were compared to Floseal.
  
  
  
  SPTT significantly decreased bleeding times in the sinonasal space compared to plain gauze (mean difference = 3.8 minutes, P = .002). All of the carotid bleeds (100%) were successfully controlled with SPTT after 10 minutes of application under pressure, compared to 25% with Floseal. No adverse events were noted, and there was no evidence of thromboembolism.
  
  
  
  SPTT significantly reduced bleeding time in a sheep model of surgical sinus bleeding and successfully stopped bleeding following catastrophic carotid artery injury, with no adverse events observed.
  
  
  
  NA Laryngoscope, 127:787-793, 2017.
authors.affiliation: Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: R Baylis
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.|Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
authors.forename: Andres
authors.initials: A
authors.lastname: Finkelstein-Kulka
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.|Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.|Hospital Espñol de México, Facultad Mexicana de Medicina, Universidad La Salle, Mexico City, Mexico.
authors.forename: Luis
authors.initials: L
authors.lastname: Macias-Valle
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jamil
authors.initials: J
authors.lastname: Manji
authors.affiliation: Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.affiliation: Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Elina
authors.initials: E
authors.lastname: Levchenko
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Okpaleke
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Al-Salihi
authors.affiliation: St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Javer
authors.affiliation: Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: J Kastrup
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D020212:Carotid Artery Injuries / Q000628:therapy*; D004195:Disease Models, Animal; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000494:pharmacology*; D010256:Paranasal Sinuses / Q000601:surgery*; D011897:Random Allocation; D034561:Sheep, Domestic; D013917:Thrombin / Q000494:pharmacology*; D014148:Tranexamic Acid / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D014148:Tranexamic Acid; D013917:Thrombin
keywords: Functional endoscopic sinus surgery; calcium carbonate; catastrophic bleeding; fibrinolysis; hemostat; intraoperative bleeding