Lokal Hemostatik Ajanlar

Bir organ ya da dokuda meydana gelen kanamanın önlenmesi süreci hemostaz olarak tanımlanır. Hemostaz mekanizmalarında bir bozukluk bulunmayan sağlıklı bireylerde kanama genellikle herhangi bir önlem gerektirmeden kendiliğinden durmaktadır. Geleneksel yöntemlere ek olarak günümüzde kanama kontrolü için bazı yardımcı ajanlar da kullanılmaktadır. Selüloz ya da kollajen içeren ajanlar, sentetik yapıştırıcılar veya fibrin içerikli maddeler bu grubun başında gelmektedir. Kitosan, ankaferd ya da zeolit gibi ajanlarda nispeten daha yeni ajanlar olarak tanımlanmaktadır. Etkinlik ve güvenilirlik açısından bu tip yeni nesil ajanlarda belli başlı soru işaretleri bulunmaktadır. Cerrahi sahanın büyüklüğü, hastanın sistemik durumu, kanama diyatezleri, hastanın kullandığı ilaçlar ya da cerrahi esnasında gelişen komplikasyonlarda lokal hemostatik ajanlar klinisyenin başarısını önemli ölçüde artırmaktadır. Bu derlemede mevcut lokal hemostatik ajanların işlevselliği ve kullanımına bağlı gelişen klinik durumlar incelenmiş, aynı zamanda akılcı kullanımıyla ilgili özellikler, endikasyonlar ve sınırlamalar değerlendirilmiştir

Local Hemostatic Agents

The process of preventing bleeding in an organ or tissue is defined as haemostasis. In healthy individuals without a defect in hemostasis mechanisms, bleeding usually stops spontaneously without any measures. In addition to conventional methods, some auxiliary agents are currently used for bleeding control. Cellulose or collagen-containing agents, synthetic adhesives or fibrin-containing substances are at the top of this group. Chitosan is defined as relatively newer agents in agents such as ankaferd or zeolite. In terms of efficiency and reliability, these new generation agents have a number of important question marks. Local haemostatic agents significantly increase the clinician’s success, especially in the size of the surgical site, the patient’s systemic condition, bleeding diathesis, the medication used by the patient, or complications during surgery. In this review, we investigated the clinical status of the local hemostatic agents and the clinical conditions associated with their use; At the same time, features, indications and limitations related to rational use were evaluated

___

  • 1. Atalan N. Hemostatik ilaçlar derleme. GKDA Derg 2014;20 (1):1-6.
  • 2. Recinos G, Inaba K, Dubose J, Demetriades D, Rhee P. Local and systemic hemostatics in trauma: A review. Travmada lokal ve sistemik hemostatik ajanlar: Derleme yazısı. Ulus Travma Acil Cerrahi Derg 2008;14(3):175-181.
  • 3. Paparo F, Denegri A, Revelli M, Puppo C, Garello I, Bacigalupo L, Garlaschi A, Rollandi L, Fornaro R. Crohn’s disease: Value of diagnostic imaging in the evaluation of anastomotic recurrence. Ann Ital Chir 2014;85(3):271-281.
  • 4. Brodbelt AR, Miles JB, Foy PM, Broome JC. Intraspinal oxidised cellulose (Surgicel) causing delayed paraplegia after thoracotomy - A report of three cases. Ann R Coll Surg Engl 2002;84(2): 97-99.
  • 5. Barnard J, Millner R. A review of topical hemostatic agents for use in cardiac surgery. Ann Thorac Surg 2009;88(4):1377-1383.
  • 6. Sundaram CP, Keenan AC. Evolution of hemostatic agents in surgical practice. Indian J Urol 2010;26(3):374-378.
  • 7. Magro-Ernica N, Magro-Filho O, Rangel-Garcia I. Histologic study of use of microfibrillar collagen hemostat in rat dental sockets. Braz Dent J 2003;14(1):12-15.
  • 8. Min j, Chiu DT, Wang Y. Variation in the heritability of body mass ındex based on diverse twin studies: A systematic review. Obes Rev 2013;14 (11):871–882.
  • 9. Matras H, Dinges HP, Lassmann H, Mamoli B. Suturefree interfascicular nerve transplantation in animal experiments. Wien Med Wochenschr 1972;122(37):517- 523.
  • 10. Tredree R, Beierlein W, Debrix I, Eisert A, Goffredo F, deSalazar EG, Rambourg P, Saint-Remy JM, Sturm C, Watson N. Evaluating the differences between fibrin sealants: Recommendations from an international advisory panel of hospital pharmacists. Eur J Hosp Pharm Sci 2006;12(1):3-9.
  • 11. Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R; BART Investigators. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358 (22): 2319-2331.
  • 12. Kjaergard HK, Fairbrother JE. Controlled clinical studies of fibrin sealant in cardiothoracic surgery: A review. Eur J Cardiothorac Surg 1996;10(9):727-733.
  • 13. Coselli JS, Bavaria JE, Fehrenbacher J, Stowe CL, Macheers SK, Gundry SR. Prospective randomized study of a protein-based tissue adhesive used as a hemostatic and structural adjunct in cardiac and vascular anastomotic repair procedures. J Am Coll Surg 2003;197(2):243-253.
  • 14. Lemaire SA, Ochoa LN, Conklin LD, Schmittling ZC, Undar A, Clubb FJ Jr, Li Wang X, Coselli JS, Fraser CD Jr. Nerve and conduction tissue injury caused by contact with BioGlue. J Surg Res 2007;143(2):286-293.
  • 15. LeMaire SA, Carter SA, Won T, Wang X, Conklin LD, Coselli JS. The threat of adhesive embolization: Bioglue leaks through needle holes in aortic tissue and prosthetic grafts. Ann Thorac Surg 2005;80(1):106-111.
  • 16. LeMaire SA, Schmittling ZC, Coselli JS, Undar A, Deady BA, Clubb FJ Jr, Fraser CD Jr. BioGlue surgical adhesive impairs aortic growth and causes anastomotic strictures. Ann Thorac Surg 2002;73(5):1500-1506.
  • 17. Galarza M, Porcar OP, Gazzeri R, Martínez-Lage JF. Microporous polysaccharide hemospheres (MPH) for cerebral hemostasis: A preliminary report. World Neurosurg 2011;75(3-4):491-494.
  • 18. Yurttas V, Sereflican M, Terzi EH, Ozyalvaçlı G, Kazaz H. Comparison of microporous polysaccharide hemospheres and ankaferd blood stopper in a rabbit epistaxis model. Eur Arch Oto-Rhino-Laryngology 2016;273(4): 933-938.
  • 19. Okamoto Y, Yano R, Miyatake K, Tomohiro I, Shigemasa Y, Minami S. Effects of chitin and chitosan on blood coagulation. Carbohydr Polym 2003;53(3):337-342.
  • 20. Rao SB, Sharma CP. Use of chitosan as a biomaterial: Studies on its safety and hemostatic potential. J Biomed Mater Res 1997;34(1):21-28.
  • 21. Abacıoğlu S, Aydın K, Büyükcam F, Kaya U, Işık B, Karakılıç ME. Comparison of the efficiencies of buffers containing ankaferd and chitosan on hemostasis in an experimental rat model with femoral artery bleeding. Turk J Haematol 2016;33(1):48-52.
  • 22. Aktop S, Emekli-Alturfan E, Ozer C, Gonul O, Garip H, Yarat A, Goker K. Effects of ankaferd blood stopper and celox on the tissue factor activities of warfarin-treated rats. Clin Appl Thromb 2014;20(1):16-21.
  • 23. Alam HB, Chen Z, Jaskille A, Querol RI, Koustova E, Inocencio R, Conran R, Seufert A, Ariaban N, Toruno K, Rhee P. Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine. J Trauma 2004; 56 (5): 974-983.
  • 24. Pusateri AE, Delgado AV, Dick EJ, Martinez RS, Holcomb JB, Ryan KL. Application of a granular mineral-based hemostatic agent (QuikClot) to reduce blood loss after grade V liver injury in swine. J Trauma 2004;57(3):555- 562.
  • 25. Wright JK, Kalns J, Wolf EA, Traweek F, Schwarz S, Loeffler CK, Snyder W, Yantis LD Jr, Eggers J. Thermal injury resulting from application of a granular mineral hemostatic agent. J Trauma 2004; 57 (2): 224-230.
  • 26. Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC. Evaluation of hemostatic effects of ankerferd as an alternative medicine. Altern Med Rev 2010;15(4):329-336.
  • 27. Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U, Ozturk Y, Firat HC. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008;36(1):163-170.
  • 28. Demiralp DO, Haznedaroglu IC, Akar N. Functional proteomic analysis of Ankaferd Blood Stopper. Turkish J Hematol 2010; 27 (2): 70-77.
  • 29. Sheela ML, Ramakrishna MK, Salimath BP. Angiogenic and proliferative effects of the cytokine VEGF in ehrlich ascites tumor cells is inhibited by glycyrrhiza glabra. Int Immunopharmacol 2006;6(3):494-498.
  • 30. Cipil HS, Kosar A, Kaya A, Uz B, Haznedaroglu IC, Goker H, Ozdemir O, Koroglu M, Kirazli S, Firat HC. In vivo hemostatic effect of the medicinal plant extract ankaferd blood stopper in rats pretreated with warfarin. Clin Appl Thromb 2009;15(3):270-276.
  • 31. Meric Teker A, Korkut AY, Kahya V, Gedikli O. Prospective, randomized, controlled clinical trial of ankaferd blood stopper in patients with acute anterior epistaxis. Eur Arch Oto-Rhino-Laryngology 2010;267(9):1377-1381.
  • 32. Ibis M, Kurt M, Onal IK, Haznedaroglu IC. Successful management of bleeding due to solitary rectal ulcer via topical application of ankaferd blood stopper. J Altern Complement Med 2008;14(9):1073-1074.
  • 33. Kurt M, Oztas E, Kuran S, Onal IK, Kekilli M, Haznedaroglu IC. Tandem oral, rectal, and nasal administrations of ankaferd blood stopper to control profuse bleeding leading to hemodynamic instability. Am J Emerg Med 2009;27(5):631.e1-631.e2.