Dursun TURKOZ, Cem DEMİREL, Hüseyin SATALOĞLU, Cengız COKLUK

Analysing the blood-stemming effect of Ankaferd Blood Stopper in medulla spinalis surgery

Background/aim: The aim of this study was to investigate the possible toxicity of the Ankaferd Blood Stopper ABS on the neural system. Materials and methods: Thirty Sprague Dawley rats were randomized into ABS n: 15 and control n: 15 groups. Following the anaesthetic induction, total laminectomy was performed to the lower thoracic, and upper lumbar areas in both groups and medulla spinalis was exposed. Two myelotomies were performed on the medulla spinalis. One millilitre ABS was applied to the incision site in the ABS group, and one millilitre 0.9% saline solution was applied in the control group. Rats were observed for 15 days regarding general behaviour, neurological signs, mobility, and signs of infection. Sixteen days later, all rats were decapitated under anaesthesia. Medulla spinalis was removed en bloc from all rats and was stained with Heamatoxylin & Eosin and luxol fast blue. Results: There was no significant difference between the ABS group and the control group regarding oedema, gliosis, the intensity of inflammatory cells, the presence of neuronal degeneration, neuron counts, and myelin degeneration. Conclusion: No clinical or histopathological evidence for the neurotoxic effect of the ABS was observed in the present study. Our findings might precipitate the use of ABS on human subjects regarding medulla spinalis surgery.

Keywords:

Ankaferd Blood Stopper, haemostasis, spinal cord,

___

1. Bilgili H, Kosar A, Kurt M, Onal IK, Goker H et al. Hemostatic efficacy of Ankaferd Blood Stopper in a swine bleeding model. Medical Principles and Practice 2009; 18 (3): 165-169. doi: 10.1159/000204344
2. Kosar A, Cipil HS, Kaya A, Uz B, Haznedaroglu IC et al. The efficacy of Ankaferd Blood Stopper in antithrombotic drug induced primary and secondary hemostatic abnormalities of a rat-bleeding model. Blood Coagulation and Fibrinolysis 2009; 20 (3): 185-190. doi: 10.1097/MBC.0b013e32831c4cb0
3. Arslan S, Haznedaroglu IC, Oz B, Goker H. Endobronchial application of Ankaferd blood stopper to control profuse lung bleeding leading to hypoxemia and hemodynamic instability. Respiratory Medicine CME 2009; 2 (3): 144-146. doi: 10.1016/j. rmedc.2008.10.016
4. Kurt M, Kacar S, Onal IK, Akdogan M, Haznedaroglu IC. Ankaferd blood stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract. Endoscopy 2008; 40 (Suppl 2): E262. doi: 10.1055/s-2008-1077648
5. Rane K, Karlsten R, Sollevi A, Gordh T, Svensson BA. Spinal cord morphology after chronic intrathecal administration of adenosine in the rat. Acta Anaesthesiologica Scandinavica 1999; 43 (10): 1035-1040.
6. Hodgson PS, Neal JM, Pollock JE, Liu SS. The neurotoxicity of drugs given intrathecally (spinal). Anesthesia and Analgesia 1999; 88: 797-809.
7. Arai T, Hoka S. Neurotoxicity of intrathecal local anesthetics. Journal of Anesthesia 2007; 21 (4): 540-542.
8. Renkens KL, Payner TD, Leipzig TJ, Feuer H, Morone MA et al. A Multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery. Spine 2001; 26 (15): 1645-1650.
9. Ereth MH, Schaff M, Ericson EF, Wetjen NM, Nuttall GA et al. Comparative safety and efficacy of topical hemostatic agents in a rat neurosurgical model. Neurosurgery 2008; 63 (4 Suppl 2): 369-372. doi: 10.1227/01.NEU.0000327031.98098.DD
10. Samudrala S. Topical hemostatic agents in surgery: a surgeon’s perspective. Association of Operating Room Nurses Journal 2008; 88 (3): S2-11. doi: 10.1016/S0001-2092(08)00586-3
11. Sabel M, Stummer W. The use of local agents: Surgicel and Surgifoam. European Spine Journal 2004; 13 (Suppl 1): S97- 101.
12. Sandrasegaran K, Lall C, Rajesh A, Maglinte D. Distinguishing gelatin bioabsorbable sponge and postoperative abdominal abscess on CT. American Journal of Roentgenology 2005; 184 (2): 475-480.
13. Brodbelt AR, Miles JB, Foy PM, Broome JC. Intraspinal oxidised cellulose (Surgicel) causing delayed paraplegia after thoracotomy–a report of three cases. Annals of the Royal College of Surgeons of England 2002; 84 (2): 97-99.
14. Sandhu GS, Elexpuru-Camiruaga JA, Buckley S. Oxidized cellulose (Surgicel) granulomata mimicking tumour recurrence. British Journal of Neurosurgery 1996; 10 (6): 617- 619.
15. Ibrahim MF, Aps C, Young CP. A foreign body reaction to Surgicel mimicking an abscess following cardiac surgery. European Journal of Cardio-Thoracic Surgery 2002; 22 (3): 489-490.
16. Banerjee T, Kendall G. Surgiceloma manifested as cauda equina syndrome. Southern Medical Journal 1998; 91 (5): 481-483.
17. Karakaya K, Ucan HB, Tascılar O, Emre AU, Cakmak GK et al. Evaluation of a new hemostatic agent Ankaferd Blood Stopper in experimental liver Laceration. Journal of Investigative Surgery 2009; 22 (3): 201-206. doi: 10.1080/08941930902866246
18. Huri E, Akgül T, Ayyildiz A, Ustün H, Germiyanoğlu C. Hemostatic role of a folkloric medicinal plant extract in a rat partial nephrectomy model: controlled experimental trial. The Journal of Urology 2009; 181 (5): 2349-2354. doi: 10.1016/j. juro.2009.01.016
19. Akkoç N, Akçelik M, Haznedaroglu İ, Göker H, Turgut M et al. In vitro anti-bacterial activities of Ankaferd medicinal plant extract. Türkiye Klinikleri Journal of Medical Sciences 2009; 29 (2): 410-415.
20. Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U et al. Haemostatic actions of the Folkloric medicinal plant extract Ankaferd Blood Stopper. The Journal of International Medical Research 2008; 36 (1): 163-170.
21. Eser O, Cosar M, Aslan A, Sahin O. Bone wax as a cause of foreign body reaction after Lumbar disc surgery: a case report. Advances in Therapy 2007; 24 (3): 594-597.
22. Hope WW, Burns J, Newcomb W, Heniford T, Sing RF. Safety and efficacy of the electrothermal bipolar vessel sealer in trauma. Injury 2009; 40 (5): 564-566. doi: 10.1016/j. injury.2008.01.024
23. Diamantis T, Kontos M, Arvelakis A, Syroukis S, Koronarchis D et al. Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surgery Today 2006; 36 (10): 908-913.
24. Özay R, Yavuz OY, Türkoğlu ME, Aktaş A, Yiğit F et al. The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model. Acta Cirurgica Brasileira 2015; 30 (12): 799-805. doi: 10.1590/S0102-865020150120000002
25. Orhan I, Dogan R, Soylu E, Aksoy F, Veyseller B et al. Histopathological evaluation of Ankaferd blood stopper use in the rabbit septoplasty model. International Journal of Pediatric Otorhinolaryngology 2015; 79 (3): 305-309. doi: 10.1016/j. ijporl.2014.11.015