A051
October 15, 2011
1:00:00 PM - 2:30:00 PM
Room Hyatt Regency 10CD
Effects of a New Microporous Polysaccharide Powder on Viscoelastic Characteristics of Clot Formation
Alexander A. Hanke, M.D., Felix Flöricke, M.D., Lion Sieg, M.S., Kai Johanning, M.D., Niels Rahe-Meyer, M.D.,Ph.D.
Hannover Medical School, Hannover, Germany


Introduction:

Microvascular bleeding is a dreaded complication in major surgery and its treatment is matter of discussion in literature. A novel approach is the use of hemostatic polysaccharide microbeads which are directly applicated onto bleeding lacerations to establish hemostasis by building a tight viscous mesh of gel and blood components.

Purpose of our study was to determine effects of such a novel polysaccharide (4DryField (4DF), PlantTec Medical, Bad Bevensen, Germany) on viscoelastic coagulation parameters as assessed by rotation thrombelastometry.

Methods:

Following IRB approval und informed consent blood samples were taken from 10 healthy volunteers. To assess effects of 4DF rotation thrombelastometry after extrinsically activation (EXTEM) was performed with addition of either 5 mg, 10 mg or 20 mg 4DF to the test (sample volume 300µl). Recorded parameters were coagulation time (CT) and maximum clot firmness (MCF). Baseline was EXTEM without test substance. For evaluation of effects under dilution all test were also performed with 50% diluted samples (Haes 6%). Analysis of variance with Bonferroni post hoc testing was performed. A p-value below 0.05 was considered to be significant.

Results:

After adding 20 mg (normal dose) 4DF rotation thrombelastometry was not able to assess clot formation resulting into irregular curves (example in fig.1) indicating highly increased coagulation time and increased clot firmness.

Results with underdose 4DF (5 mg, 10 mg) are displayed in figures 2 and 3. They indicate that 4DF significantly reduces CT (p=0.011) and increases MCF (p<0.001) in native blood as it does in diluted blood (CT: p=0.002; MCF: p<0.0001). In native blood coagulation parameters were improved to the upper level of normal range. In 50% Haes diluted blood EXTEM values were improved from severely reduced to slightly below normal range.

Conclusion:

Application of 4DF significantly increases speed of coagulation and clot firmness - even under conditions of dilutional coagulopathy. With normal dose 4DF the firmness of clot in 50% Haes diluted blood is comparable to that of a native coagulum and might be capable to seal microvascular bleeding areas. Further clinical trials are necessary to prove in vivo efficacy.

Figure 1
Figure 2
Figure 3

Copyright © 2011 American Society of Anesthesiologists