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Controlling Hepatic Bleeding

Clinician's Brief (Capsule)

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This study compared the benefits of two hemostatic agents in postoperative hepatic bleeding. Because of the liver’s high vascularity, biopsy, trauma, or resection can produce bleeding that may be difficult to control. This study compared a thrombin-containing new-generation topical surgical hemostatic agent (gelatin matrix) to a hemostatic gelatin sponge. To construct the matrix, a bovine-derived gelatin matrix and a human-derived thrombin component are combined in the surgical field to create 5 mL of a highly viscous, flowable gel that can be applied to the surgery site of the liver using a syringe and plastic applicator tip. Each of 14 dogs had 2 liver biopsies taken via laparotomy. One biopsy site was treated with the gelatin matrix, the other with a gelatin sponge. Sites treated with the gelatin matrix achieved hemostasis more quickly (136 seconds vs 373 seconds) and had less blood loss (0.12 mL vs 1.18 mL). Adverse reactions were monitored for the first 24 hours; none were seen. The gelatin matrix was concluded to be a safe and more effective means to control bleeding after taking biopsies from the liver.

Commentary

Bleeding following biopsy of the liver can be substantial in a small number of cases. Gelfoam (pfizer.com), VetSpon (vetspon.novartis.us), and Surgicel (ethicon360.com) are just 3 commonly used topical devices for quelling liver hemorrhage.1 Based on this study, FloSeal (floseal.com) caused liver hemorrhage subsidence faster than Vetspon; however, the FloSeal was reportedly 18 times the cost of other alternatives, so less expensive agents will likely remain more popular for surgeons, at least for now.—Jonathan Miller, DVM, MS, DACVS

Source 

Evaluation of a gelatin matrix as a topical hemostatic agent for hepatic bleeding in the dog. Polidoro DP, Kass PH. JAAHA 49:308-317, 2013.

1. Hemostatic agents in hepatobiliary and pancreas surgery: A review of the literature and critical evaluation of a novel carrier-bound fibrin sealant (TachoSil). Simo KA, Hanna EM, Imigawa DK, Iannitti DA. ISRN Surg doi: 10.5402/2012/729086.

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