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Comparison of hemostatic dressings for superficial wounds using a new spectrophotometric coagulation assay.

Rembe JD, Böhm JK, Fromm-Dornieden C, Schäfer N, Maegele M, Fröhlich M, Stuermer EK - J Transl Med (2015)

Bottom Line: For this purpose the clotting times of blood under the influence of the named hemostatics from healthy volunteers were compared with Marcumar(®) or ASS(®) treated patients.QuikClot(®), oxidized cellulose and unexpectedly alginate-L were superior to chitosan and Lyostypt(®).Due to its additional well-known positive effect on wound healing alginate-L should be considered for further investigations.

View Article: PubMed Central - PubMed

Affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. julian-dario.rembe@uni-wh.de.

ABSTRACT

Background: Due to demographical changes the number of elderly patients depending on oral anticoagulation is expected to rise. Prolonged bleeding times in case of traumatic injuries represent the drawback of these medications, not only in major trauma, but also in superficial wounds. Therefore, dressings capable of accelerating coagulation onset and shortening bleeding times are desirable for these patients.

Methods: The hemostatic potential and physical properties of different types of superficial wound dressings (standard wound pad, two alginates, chitosan, collagen (Lyostypt(®)), oxidized cellulose, and QuikClot(®)) were assessed in vitro. For this purpose the clotting times of blood under the influence of the named hemostatics from healthy volunteers were compared with Marcumar(®) or ASS(®) treated patients. For that, a newly developed coagulation assay based on spectrophotometric extinction measurements of thrombin activity was used.

Results: The fastest coagulation onset was observed for oxidized cellulose (Ø 2.47 min), Lantor alginate-L (Ø 2.50 min) and QuikClot(®) (Ø 3.01 min). Chitosan (Ø 5.32 min) and the collagen Lyostypt(®) (Ø 7.59 min) induced clotting comparatively late. Regarding physical parameters, QuikClot(®) showed the lowest absorption capacity and speed while chitosan and both alginates achieved the highest. While oxidized cellulose displayed the best clotting times, unfortunately it also revealed low absorption capacity.

Conclusions: All tested specimens seem to induce clotting independently from the administered type of oral anticoagulant, providing the possibility to neglect the disadvantage in clotting times arising from anticoagulation on a local basis. QuikClot(®), oxidized cellulose and unexpectedly alginate-L were superior to chitosan and Lyostypt(®). Due to its additional well-known positive effect on wound healing alginate-L should be considered for further investigations.

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Clotting time (in minutes) induced by the different investigated wound pads and a control without specimen application. Results were assessed via spectrophotometric extinction measurement of thrombin activity. a Healthy volunteers, b Marcumar® patients, c ASS® patients, d summarized graphic depiction of all groups (statistics not reported). Values are expressed as means ± STD. (*p < 0.05 vs. control; #p < 0.05 vs. standard wound pad; °p < 0.05 vs. alginate-d; ●p < 0.05 vs. oxidized cellulose; ϫp < 0.05 vs. Lyostypt®)
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Fig4: Clotting time (in minutes) induced by the different investigated wound pads and a control without specimen application. Results were assessed via spectrophotometric extinction measurement of thrombin activity. a Healthy volunteers, b Marcumar® patients, c ASS® patients, d summarized graphic depiction of all groups (statistics not reported). Values are expressed as means ± STD. (*p < 0.05 vs. control; #p < 0.05 vs. standard wound pad; °p < 0.05 vs. alginate-d; ●p < 0.05 vs. oxidized cellulose; ϫp < 0.05 vs. Lyostypt®)

Mentions: The spectrophotometric analysis of all tested wound pads showed a remarkable significant reduction in clotting time compared to the untreated positive control as well as to a standard wound pad (negative control) for all three groups (Fig. 4a–c). QuikClot®, oxidized cellulose and alginate-l demonstrated significantly faster clotting times than the materials chitosan or collagen (Lyostypt®). Of the latter, chitosan had the tendency to induce clotting faster than the established Lyostypt®. The coagulation onset of alginate-l is nearly the same (healthy: 2.46 ± 0.35 min; Marcumar®: 3.06 ± 0.45 min; ASS®: 2.40 ± 0.24 min) as that of the well known and already established QuikClot® (healthy: 3.13 ± 0.39 min; Marcumar®: 2.51 ± 0.43 min; ASS®: 2.59 ± 0.51 min). In contrast, alginate-d manufactured by another company (Dr. Ausbüttel & Co., Witten, Germany) could not reach this level. However, its clotting induction time was still significantly shorter than that of the standard wound pad.Fig. 4


Comparison of hemostatic dressings for superficial wounds using a new spectrophotometric coagulation assay.

Rembe JD, Böhm JK, Fromm-Dornieden C, Schäfer N, Maegele M, Fröhlich M, Stuermer EK - J Transl Med (2015)

Clotting time (in minutes) induced by the different investigated wound pads and a control without specimen application. Results were assessed via spectrophotometric extinction measurement of thrombin activity. a Healthy volunteers, b Marcumar® patients, c ASS® patients, d summarized graphic depiction of all groups (statistics not reported). Values are expressed as means ± STD. (*p < 0.05 vs. control; #p < 0.05 vs. standard wound pad; °p < 0.05 vs. alginate-d; ●p < 0.05 vs. oxidized cellulose; ϫp < 0.05 vs. Lyostypt®)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4666077&req=5

Fig4: Clotting time (in minutes) induced by the different investigated wound pads and a control without specimen application. Results were assessed via spectrophotometric extinction measurement of thrombin activity. a Healthy volunteers, b Marcumar® patients, c ASS® patients, d summarized graphic depiction of all groups (statistics not reported). Values are expressed as means ± STD. (*p < 0.05 vs. control; #p < 0.05 vs. standard wound pad; °p < 0.05 vs. alginate-d; ●p < 0.05 vs. oxidized cellulose; ϫp < 0.05 vs. Lyostypt®)
Mentions: The spectrophotometric analysis of all tested wound pads showed a remarkable significant reduction in clotting time compared to the untreated positive control as well as to a standard wound pad (negative control) for all three groups (Fig. 4a–c). QuikClot®, oxidized cellulose and alginate-l demonstrated significantly faster clotting times than the materials chitosan or collagen (Lyostypt®). Of the latter, chitosan had the tendency to induce clotting faster than the established Lyostypt®. The coagulation onset of alginate-l is nearly the same (healthy: 2.46 ± 0.35 min; Marcumar®: 3.06 ± 0.45 min; ASS®: 2.40 ± 0.24 min) as that of the well known and already established QuikClot® (healthy: 3.13 ± 0.39 min; Marcumar®: 2.51 ± 0.43 min; ASS®: 2.59 ± 0.51 min). In contrast, alginate-d manufactured by another company (Dr. Ausbüttel & Co., Witten, Germany) could not reach this level. However, its clotting induction time was still significantly shorter than that of the standard wound pad.Fig. 4

Bottom Line: For this purpose the clotting times of blood under the influence of the named hemostatics from healthy volunteers were compared with Marcumar(®) or ASS(®) treated patients.QuikClot(®), oxidized cellulose and unexpectedly alginate-L were superior to chitosan and Lyostypt(®).Due to its additional well-known positive effect on wound healing alginate-L should be considered for further investigations.

View Article: PubMed Central - PubMed

Affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. julian-dario.rembe@uni-wh.de.

ABSTRACT

Background: Due to demographical changes the number of elderly patients depending on oral anticoagulation is expected to rise. Prolonged bleeding times in case of traumatic injuries represent the drawback of these medications, not only in major trauma, but also in superficial wounds. Therefore, dressings capable of accelerating coagulation onset and shortening bleeding times are desirable for these patients.

Methods: The hemostatic potential and physical properties of different types of superficial wound dressings (standard wound pad, two alginates, chitosan, collagen (Lyostypt(®)), oxidized cellulose, and QuikClot(®)) were assessed in vitro. For this purpose the clotting times of blood under the influence of the named hemostatics from healthy volunteers were compared with Marcumar(®) or ASS(®) treated patients. For that, a newly developed coagulation assay based on spectrophotometric extinction measurements of thrombin activity was used.

Results: The fastest coagulation onset was observed for oxidized cellulose (Ø 2.47 min), Lantor alginate-L (Ø 2.50 min) and QuikClot(®) (Ø 3.01 min). Chitosan (Ø 5.32 min) and the collagen Lyostypt(®) (Ø 7.59 min) induced clotting comparatively late. Regarding physical parameters, QuikClot(®) showed the lowest absorption capacity and speed while chitosan and both alginates achieved the highest. While oxidized cellulose displayed the best clotting times, unfortunately it also revealed low absorption capacity.

Conclusions: All tested specimens seem to induce clotting independently from the administered type of oral anticoagulant, providing the possibility to neglect the disadvantage in clotting times arising from anticoagulation on a local basis. QuikClot(®), oxidized cellulose and unexpectedly alginate-L were superior to chitosan and Lyostypt(®). Due to its additional well-known positive effect on wound healing alginate-L should be considered for further investigations.

Show MeSH
Related in: MedlinePlus