One of the underlying challenges in any surgical procedure is to maintain or regain hemostasis. Classic surgical training reinforces the axiom that careful attention to surgical hemostasis can help reduce blood loss and transfusion and ultimately improve patient outcomes. There are many challenges to hemostasis in the vascular surgery population due to advanced age at presentation, prior procedures/medical history, and the use of prophylactic anticoagulant and antiplatelet medications. Fortunately, advances in preoperative assessment, perioperative care, and topical hemostatic agents have provided new tools for managing hemostasis in surgery. This article highlights a new hemostatic agent developed through the use of recombinant DNA (rDNA) technology.To get more news about IFAK, you can visit rusuntacmed.com official website. FACTORS THAT IMPAIR HEMOSTASIS Complications that affect bleeding in vascular surgery procedures may be related to technical or pathophysiologic factors. In addition, patients who require surgery may be receiving prophylactic or therapeutic anticoagulant medications, which create additional hemostasis challenges. Among the technical causes of intraoperative bleeding are suture line breakage, suture malfunction or malposition, anatomical variation, and unrecognized vascular injury.
Pathophysiologic factors, such as hypothermia and acidosis, may slow the coagulation cascade and impair platelet function; furthermore, loss of adequate blood volume and associated clotting factors can affect hemostasis. Tissue injury, vasculopathy, vascular and extravascular volume shifts, and illness during and after surgery can also disrupt the physiologic balance.1 Perioperative complications and iatrogenic factors add to the risks of bleeding, including infection, transfusion-related reactions, prolonged procedures, postoperative coagulopathy, and anticoagulant medications.2,3 Given the complex and diverse nature of these bleeding challenges, numerous techniques and agents have been developed to speed hemostasis. Once major vascular bleeding has been controlled and after adequate fluid resuscitation, pharmacologic intervention, including topical and systemic hemostatic agents, may be indicated.
USE OF TOPICAL THROMBIN Topical hemostatic agents are useful adjuncts in vascular surgery. They are categorized by their mechanism of action and composition and can be considered passive or active, depending on the absence or presence of thrombin.
Thrombin, the central, critical component in coagulation, is formed through a highly regulated series of amplification reactions. Thrombin converts fibrinogen to fibrin and activates platelets and factor XIII. The thrombus develops as gelatinous fibrin polymers bind and entrap additional platelets and red blood cells, gaining added strength from factor XIII-induced cross-linking that ultimately results in hemostasis.
The first report by Warner in 1939 of recognizable efficacy with topical thrombin led to its preparation and use in surgery.4 In the ensuing decades, and long before the era of controlled clinical trials, the prominent clinical utility of topical thrombin led to widespread clinical acceptance. Up until recently, only thrombin derived from either bovine or human plasma sources was applied topically in a variety of surgical settings. Thrombin is also included as a hemostatic component in vascular sealing devices, wound dressings, and fibrin sealants. In 2007, an estimated 1 million patients in the US underwent surgical procedures in which topical thrombin was used as a hemostatic agent.5
