Erkan YAVUZ, M. Uygar KALAYCI, Sevgi KESİCİ, UĞUR KESİCİ, Selvinaz ÖZKARA, Orhan YALÇIN

Efficacy of Ankaferd blood stopper in bleeding control in experimental partial splenectomy model

Topikal hemostatik ajanlar travma sonrası ve operasyon esnasındaki kanamaların durdurulmasına yardım amacıyla kullanılmaktadır. Ankaferd Blood Stopper (ABS) Türkiye’de üretilmiş bir hemostatik ajandır. Çalışmamızda deneysel splenektomi modelinde bu ajanın etkinliğinin ortaya konulması ve klinikte kullanılan Fibrin Glue (Tisseel®) ile karşılaştırılması planlandı. Bu çalışmada 40 adet Wistar Albino dişi sıçan kullanıldı. Randomizasyon yöntemi ile 5 eşit grup oluşturuldu. Grup 1, Sham; Grup 2, Kontrol; Grup 3, Dikiş; Grup 4, Fibrin Glue (Tisseel®) ve Grup 5, Ankaferd Bloob Stopper. Çalışmamızda sıçanlara başlangıç hematokrit değeri bakıldıktan sonra parsiyel splenektomi kanama modeli uygulandı. Her grupta farklı yöntem ile kanama kontrolü sağlandı. Gruplardaki tüm sıçanların kanama sürelerine bakıldı. Beşinci gün tüm sıçanlar son hematokrit değeri bakıldıktan sonra sakrifiye edildi. Batın içi hematom varlığı, yapışıklık değerlendirilerek patolojik inceleme için splenektomi uygulandı. Gruplar kanama süresi ve kan kaybı açısından karşılaştırıldı. Grup 5, Grup 2 ve Grup 3’e göre daha etkin, Grup 4 ile ise eşdeğer bulundu. Patolojik değerlendirmede fibrozis ve koagülasyon nekrozu açısından anlamlı düzeyde daha az yan etki saptandı. Sonuçta Ankaferd Blood Stopper’ın fibrin glue ile eşdeğer etkinlikte, güvenli ve daha düşük maliyetli olduğu sonucuna varıldı.

Anahtar Kelimeler:

hayvan modelleri, kardiyovasküler ajanlar, hematokrit, hematoloji, kanama, sıçan, dalak, splenektomi, cerrahi, cerrahi işlemler

Deneysel parsiyel splenektomi modelinde kanama kontrolünde ankaferd blood stopper’ın etkinliği

Topical hemostatic agents are used as auxiliary agents for bleeding post trauma and during operation. Ankaferd Blood Stopper (ABS) is an hemostatic agent that is produced in Turkey. We planned to demonstrate the efficacy of this agent in experimental splenectomy model and to compare it with Fibrin Glue (Tisseel®) used in clinics. Forty Wistar Albino female rats were divided in 5 groups. Group 1, Sham; Group 2, Control; Group 3, Suture; Group 4, Fibrin Glue (Tisseel®) and Group 5, Ankaferd Blood Stopper. Partial splenectomy bleeding model was applied to rats after initial hematocrit values were measured. Bleeding in each group was controlled by a different method. Bleeding times of the rats were determined. All the rats were sacrificed on the 5th day after the last hematocrit values were measured. Existence of intraabdominal hematoma and adhesiveness were evaluated and splectonomy was applied for pathological examination. Groups were compared with respect to bleeding time and blood loss and Group 5 and Group 2 were determined to be more effective than Group 3 but Group 4 was determined to be equivalent. Fewer side effects at significant levels were detected in terms of fibrosis and coagulation necrosis during pathological assessment. In conclusion, in spleen bleedings when compared with fibrin glue, Ankaferd Blood Stopper is equally effective and safe and its price is lower.

Keywords:

animal models, cardiovascular agents, haematocrit, haematology, haemorrhage, rats, spleen, splenectomy, surgery, surgical operations,

PDF

___

1. Uranus S, Mischinger HJ, Pfeifer J, Kronberger L Jr, Rabl H, Werkgartner G, Steindorfer P, Kirz JK: Hemostatic methods for the management of spleen and liver injuries. World J Surg, 20 (8): 1107-1111, 1996.
2. Knudson MM, Maull KI: Nonoperative management of solid organ injuries. Surg Clin North Am, 79 (6): 1357-1371, 1999.
3. Turner AS, Parker D, Egbert B, Maroney M, Armstrong R, Powers N: Evaluation of a novel hemostatic device in Anovine parenchymal organ bleeding model of normal and impaired hemostasis. J Biomed Mater Res, 63 (1): 37-47, 2002.
4. Bochicchio GV, Arciero C, Scalea TM: The hemostat wrap’ A new technique in splenorrhaphy. J Trauma, 59 (4): 1003-1006, 2005.
5. Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U, Ozturk Y, Fırat HC: The folkloric medicinal plant extract Ankaferd Blood Stopper®. J Int Med Res, 36 (1): 163-170, 2008.
6. Ibis M, Kurt M, Onal I, Haznedaroglu IC: Successful management of bleeding due to solitary rectal ulcer via topical application of Ankaferd Blood Stopper. J Altern Complement Med, 14 (9): 1073-1074, 2008.
7. Bilgili H, Kosar A, Kurt M, Onal IK, Goker H, Captug O, Shorbagi A, Turgut M, Kekilli M, Kurt Ok, Kirazli S, Aksu S, Haznedaroglu IC: hemostatic efficacy of ankaferd blood stopper in a swine bleeding model. Med Princ Pract, 18 (3): 165-169, 2009.
8. King H, Shumacker HB Jr: Splenic studies: Susceptibility to infection after splenektomi performed in infancy. Ann Surg, 136 (2): 239-242, 1952.
9. Karp MP, Cooney DR, Pros GA, Newman BM, Jewett TC Jr: The nonoperative management of pediatric hepatic trauma. J Pediatr Surg, 18 (4): 512-518, 1983.
10. Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW: Management of blunt splenic injury in children: Evolution of the nonoperative approach. J Pediatr Surg, 44 (5): 1005-1008, 2009.
11. Kuzu A, Aydintug S, Karayalcın K, Koksoy C, Yerdel MA, Eraslan S: Use of autologe fibrin glue in the treatment of splenic trauma: An experimental trauma. J R Coll Surg Edinb, 37 (3): 162-164, 1992.
12. Karakaya K, Ucan A, Tascılar O, Emre AU, Cakmak GK, Irkorucu O, Ankarali H, Comert M: Evaluation of a new hemostatic agent Ankaferd Blood Stopper in experimental liver laceration. J Invest Surg, 22 (3): 201-206, 2009.
13. Demiralp DO, Haznedaroglu IC, Akar N: Functional proteomic analysis of Ankaferd Blood Stopper. Turk J Hematology, 27, 70-77, 2010.
14. Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC: Evaluation of hemostatic effects of Ankaferd as an alternative medicine. Altern Med Rev, 15, 329-336, 2010.
15. Yilmaz E, Gulec S, Torun D, Haznedaroglu IC, Akar N: The effects of of Ankaferd Blood Stopper on transcription factors in HUVEC and erythrocyte protein profile. Turk J Hematol, DOI:10.5152/tjh.2011.39. 2011.
16. Bothin C, Okada M, Midtvedt T, Perbeck L: The intestinal flora influences adhesion formation around surgical anostomoses. Br J Surg, 88 (1): 143-145, 2001.
17. Buntain WL, Gould HR: Splenic trauma in children and techniques of splenic salvage. World J Surg, 9 (3): 398-409, 1985.
18. Canturk NH, Utkan NZ, Analay H, Yildirir C, Dulger M: The prognostic factors in major gastroenteric injuries from blunt trauma. Ulus Travma Acil Cerrahi Derg, 4 (1): 70-75, 1998.
19. Karabiyik A, Yilmaz E, Gulec S, Haznedaroglu IC, Akar N: Dual diverse dynamic reversible actions of Ankaferd on EPCR and PAI-1 inside vascular endothelial cells with and without LPS. Turk J Hematol, DOI: 10.5152/tjh.2011.41. 2011.
20. Ulus TA, Turan NN, Özyalçın S, Aydoğ G, Ulus F, Göker H, Haznedaroglu IC: Surgical and histopathological effects of topical ankaferd hemostat on major arterial vessel injury in relation to the enhanced intra-arterial blood pressure. Turk J Hematol, DOI: 10.5152/tjh.2011.21. 2011.
21. Iynen I, Sogut O, Kose R: The efficacy of Ankaferd Blood Stopper in Heparin-induced hemostatic abnormality in a rat epistaxis model. Otolaryngol Head Neck Surg, 145 (5): 840-844, 2011.